Provider Demographics
NPI:1285763607
Name:DEMETER, LELA (MD)
Entity type:Individual
Prefix:
First Name:LELA
Middle Name:
Last Name:DEMETER
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 1:7270 W COLLEGE DR STE 203
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1180
Mailing Address - Country:US
Mailing Address - Phone:708-923-1900
Mailing Address - Fax:708-923-1119
Practice Address - Street 1:7270 W COLLEGE DR STE 203
Practice Address - Street 2:SUITE 130
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1180
Practice Address - Country:US
Practice Address - Phone:708-923-1900
Practice Address - Fax:708-923-1119
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-098873207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK49394Medicare PIN
IL528440Medicare PIN
ILG84892Medicare UPIN