Provider Demographics
NPI:1013482777
Name:ELAYAN, AMANI JAMIL
Entity Type:Individual
Prefix:
First Name:AMANI
Middle Name:JAMIL
Last Name:ELAYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9113 REDCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-3789
Mailing Address - Country:US
Mailing Address - Phone:708-407-6822
Mailing Address - Fax:
Practice Address - Street 1:9701 W HIGGINS RD STE 270
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-4703
Practice Address - Country:US
Practice Address - Phone:815-654-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant