Provider Demographics
NPI:1154366839
Name:ELSER, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:ELSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2850 W 95TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2735
Mailing Address - Country:US
Mailing Address - Phone:708-425-9550
Mailing Address - Fax:708-229-6084
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-425-9550
Practice Address - Fax:708-229-6084
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036080970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036080970Medicaid
ILE47892Medicare UPIN
IL036080970Medicaid
IL924803Medicare ID - Type Unspecified