Provider Demographics
NPI:1912122383
Name:ELENA FITCHEV MD LTD
Entity type:Organization
Organization Name:ELENA FITCHEV MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITCHEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-328-3213
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092221Medicaid
IL611340Medicare ID - Type Unspecified