Provider Demographics
NPI:1265431712
Name:FLORESSTADLER, ELBIO M (MD)
Entity type:Individual
Prefix:DR
First Name:ELBIO
Middle Name:M
Last Name:FLORESSTADLER
Suffix:
Gender:M
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:PO BOX 74821
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60694-4821
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:1 INGALLS DR
Practice Address - Street 2:PATHOLOGY DEPT.
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3558
Practice Address - Country:US
Practice Address - Phone:708-915-5763
Practice Address - Fax:708-915-3786
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093150207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093150Medicaid
IL036093150Medicaid
ILCC3182Medicare PIN
ILL65477Medicare PIN
IL222024143Medicare PIN
ILG77696Medicare UPIN
ILL65478Medicare PIN
IL379820Medicare PIN