Provider Demographics
NPI:1922696533
Name:ELDRIDGE, COURTNI MARIE (CPHT)
Entity Type:Individual
Prefix:
First Name:COURTNI
Middle Name:MARIE
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S LEAVITT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3116
Mailing Address - Country:US
Mailing Address - Phone:815-618-2092
Mailing Address - Fax:
Practice Address - Street 1:5000 S 5TH AVE BLDG 37
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-786-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060776961207PE0004X
IL049.272946183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services