Provider Demographics
NPI:1457430852
Name:ROY, ESTEFAN GARLIT (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTEFAN
Middle Name:GARLIT
Last Name:ROY
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 2284
Mailing Address - Street 2:
Mailing Address - City:SCHILLER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60176-0284
Mailing Address - Country:US
Mailing Address - Phone:847-685-9326
Mailing Address - Fax:847-685-9329
Practice Address - Street 1:5600 W ADDISON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4401
Practice Address - Country:US
Practice Address - Phone:773-577-2141
Practice Address - Fax:773-577-4143
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC38193Medicare UPIN
IL771680Medicare ID - Type Unspecified