Provider Demographics
NPI:1851333025
Name:PARKER, ELIZA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:M
Last Name:PARKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 E OAK STREET, 6R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1231
Mailing Address - Country:US
Mailing Address - Phone:312-915-0195
Mailing Address - Fax:800-858-1097
Practice Address - Street 1:34 E OAK STREET, 6R
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1231
Practice Address - Country:US
Practice Address - Phone:312-915-0195
Practice Address - Fax:800-858-1097
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123192208000000X
MI4301086462208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4779704Medicaid
MIEP086462OtherBC/BS
MI4779704Medicaid
MIM60650249Medicare PIN