Provider Demographics
NPI:1912992561
Name:LAMBIASE, ELYSE A (MD)
Entity Type:Individual
Prefix:MS
First Name:ELYSE
Middle Name:A
Last Name:LAMBIASE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:LL7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:773-293-4197
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:STE 557
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3456
Practice Address - Country:US
Practice Address - Phone:847-869-2076
Practice Address - Fax:847-475-3414
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036064464207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050081Medicaid
IL5042670001Medicare NSC
ILC42155Medicare UPIN