Provider Demographics
NPI:1821135948
Name:LELA DEMETER MD PC
Entity Type:Organization
Organization Name:LELA DEMETER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMETER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-479-6522
Mailing Address - Street 1:11824 SOUTHWEST HWY STE 130
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2658
Mailing Address - Country:US
Mailing Address - Phone:708-923-1900
Mailing Address - Fax:708-923-1119
Practice Address - Street 1:11824 SOUTHWEST HWY STE 130
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2658
Practice Address - Country:US
Practice Address - Phone:708-923-1900
Practice Address - Fax:708-923-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098873207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098873Medicaid
IL036098873Medicaid
IL528440Medicare ID - Type Unspecified
ILK49394Medicare PIN