Provider Demographics
NPI:1982779047
Name:FITCHEV, ELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:FITCHEV
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 1:800 AUSTIN ST STE 502W
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3445
Mailing Address - Country:US
Mailing Address - Phone:847-328-3213
Mailing Address - Fax:847-328-2871
Practice Address - Street 1:800 AUSTIN ST STE 502W
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3445
Practice Address - Country:US
Practice Address - Phone:847-328-3213
Practice Address - Fax:847-328-2871
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627173OtherBCBS
IL036092221Medicaid
IL900015526OtherTIN