Provider Demographics
NPI:1912907247
Name:KOMAROVSKY, ELLA (MD)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:KOMAROVSKY
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 1:3350 W SALT CREEK LN
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-5023
Mailing Address - Country:US
Mailing Address - Phone:847-952-7460
Mailing Address - Fax:847-222-1754
Practice Address - Street 1:1000 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1777
Practice Address - Country:US
Practice Address - Phone:847-425-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361061062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106106Medicaid
363045007OtherTAX ID#
IL036106106Medicaid
363045007OtherTAX ID#