Provider Demographics
NPI:1356446306
Name:LEONARD D ELKUN MD SC
Entity type:Organization
Organization Name:LEONARD D ELKUN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ELKUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-943-8322
Mailing Address - Street 1:411 W ONTARIO ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6945
Mailing Address - Country:US
Mailing Address - Phone:312-943-8322
Mailing Address - Fax:312-943-8323
Practice Address - Street 1:411 W ONTARIO ST
Practice Address - Street 2:SUITE 402
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-6945
Practice Address - Country:US
Practice Address - Phone:312-943-8322
Practice Address - Fax:312-943-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021604911Medicare UPIN
IL478070Medicare ID - Type Unspecified