Individual
DR. ELLIOTT MCKINLEY FOURTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10661 S ROBERTS RD, 103, PALOS HILLS, IL 60465-1954
(708) 974-9999
(708) 974-9985
Mailing address
8836 S. ASHLAND, CHICAGO, IL 60620
(773) 629-6036
(773) 629-6852
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36117052
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36117052
STATE MEDICAL LICENSE
IL
Enumeration date
10/16/2006
Last updated
10/26/2012
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