Provider Demographics
NPI:1356356166
Name:NYE, ELIZABETH ROBIN (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROBIN
Last Name:NYE
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 1:345 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-2109
Mailing Address - Country:US
Mailing Address - Phone:312-670-2530
Mailing Address - Fax:312-670-2630
Practice Address - Street 1:345 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-2109
Practice Address - Country:US
Practice Address - Phone:312-670-2530
Practice Address - Fax:312-670-2630
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074722207VX0000X, 207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1821211129OtherGROUP NPI
IL036074722Medicaid
IL31603891OtherBC/BS PROVIDER NUMBER
IL1356356166OtherINDIVIDUAL NPI
IL31603891OtherBC/BS PROVIDER NUMBER
ILK06438Medicare PIN
IL036074722Medicaid