Basic Information
| Provider Information | |||||||||
| NPI: | 1841727476 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELMUTI | ||||||||
| FirstName: | LENA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 PARK AVE. WEST | ||||||||
| Address2: | PEDIATRIC HOSPITALISTS | ||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600352433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475702530 | ||||||||
| FaxNumber: | 8475700231 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 PARK AVE. WEST | ||||||||
| Address2: | PEDIATRIC HOSPITALISTS | ||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600352433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475702530 | ||||||||
| FaxNumber: | 8475700231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2017 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 125070267 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 036152952 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.