Provider Demographics
NPI:1205082633
Name:CHAHLA, ELIE JEAN (MD)
Entity type:Individual
Prefix:
First Name:ELIE
Middle Name:JEAN
Last Name:CHAHLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:340 W LINCOLN ST
Mailing Address - Street 2:SUITE 540
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1900
Mailing Address - Country:US
Mailing Address - Phone:618-222-1430
Mailing Address - Fax:618-222-4787
Practice Address - Street 1:224 S WOODS MILL RD STE 410S
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3605
Practice Address - Country:US
Practice Address - Phone:366-857-7956
Practice Address - Fax:314-590-5959
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011020278207R00000X, 208M00000X, 207RG0100X
IL036140401207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1205082633Medicaid
MO139000066Medicare PIN