Provider Demographics
NPI:1265522866
Name:HORVATH, LAURA ELISE (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELISE
Last Name:HORVATH
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 1:4405 WEAVER PKWY
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3269
Mailing Address - Country:US
Mailing Address - Phone:630-352-5300
Mailing Address - Fax:630-352-5499
Practice Address - Street 1:4405 WEAVER PKWY
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3269
Practice Address - Country:US
Practice Address - Phone:630-352-5300
Practice Address - Fax:630-352-5499
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5645240-1205207RX0202X
IL036104090207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00904919OtherMEDICARE RAILROAD (INDIVIDUAL)
206147040OtherMEDICARE PTAN (INDIVIDUAL)
IL0222075OtherCDPG BLUE CROSS
CA4748OtherMEDICARE RAILROAD (GROUP)
IL1033149844OtherCDPG NPI
206147OtherMEDICARE PTAN (GROUP)