# ELEMENTAL MEDICAL CENTER LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164935169
- **Authorized official:** DR. MARTINS A ADEOYE MD (CEO)
- **Authorized official phone:** (331) 330-9955

## Contact information

- **Practice address:** 612 S WESTERN AVE APT 1, CHICAGO, IL 60612-4682
- **Practice address phone:** (331) 330-9955
- **Practice address fax:** (708) 892-2909
- **Mailing address:** 15010 S RAVINIA AVE STE 15, ORLAND PARK, IL 60462-5353
- **Mailing address phone:** (331) 330-9955

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | 036103889 | IL | Yes |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |

## Other

- **Enumeration date:** 11/13/2017
- **Last updated:** 10/22/2024