Basic Information
Provider Information
NPI: 1124071147
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ELAHI
FirstName: SADAF
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 120 W. 22ND ST.
Address2: NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS
City: OAK BROOK
State: IL
PostalCode: 60523
CountryCode: US
TelephoneNumber: 6309745240
FaxNumber: 6309745274
Practice Location
Address1: 5201 S. WILLOW SPRINGS RD.
Address2: S-260
City: LAGRANGE
State: IL
PostalCode: 60525
CountryCode: US
TelephoneNumber: 7083541306
FaxNumber: 7083541538
Other Information
ProviderEnumerationDate: 05/19/2006
LastUpdateDate: 12/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300X036109435ILY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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