Provider Demographics
NPI:1982749149
Name:JOHN ELSTROM, MD, PC
Entity Type:Organization
Organization Name:JOHN ELSTROM, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-344-3050
Mailing Address - Street 1:406 N FRONT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5593
Mailing Address - Country:US
Mailing Address - Phone:815-334-3050
Mailing Address - Fax:815-334-3822
Practice Address - Street 1:406 N FRONT ST
Practice Address - Street 2:SUITE C
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5593
Practice Address - Country:US
Practice Address - Phone:815-334-3050
Practice Address - Fax:844-971-6456
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN ELSTROM, MD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-21
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209940Medicare PIN
IL0418460001Medicare NSC