Provider Demographics
NPI:1295876563
Name:YILDIZ, ELAINE S (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:S
Last Name:YILDIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 N. GREENBAY ROAD
Mailing Address - Street 2:
Mailing Address - City:N. CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064
Mailing Address - Country:US
Mailing Address - Phone:847-688-1900
Mailing Address - Fax:224-610-2913
Practice Address - Street 1:3001 N. GREENBAY ROAD
Practice Address - Street 2:
Practice Address - City:N. CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:847-688-1900
Practice Address - Fax:224-610-2913
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-000896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant