Provider Demographics
NPI:1316351539
Name:POLI, ELIZABETH CARLA (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CARLA
Last Name:POLI
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 1:777 PARK AVE W STE B400
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2433
Mailing Address - Country:US
Mailing Address - Phone:847-570-1700
Mailing Address - Fax:847-926-5393
Practice Address - Street 1:777 PARK AVE W STE B400
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2433
Practice Address - Country:US
Practice Address - Phone:847-570-1700
Practice Address - Fax:847-926-5393
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361411462086X0206X
TXT1810208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX428828401Medicaid
TX428828402OtherCSHCN