Individual
DR. ELSY A DEVASSY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
16612 W 159TH ST, SUITE 204, LOCKPORT, IL 60441-8006
(815) 588-3900
(815) 588-1414
Mailing address
16612 W 159TH ST, SUITE 204, LOCKPORT, IL 60441-8006
(815) 588-3900
(815) 588-1414
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036063297
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036063297
—
IL
Enumeration date
05/31/2005
Last updated
01/22/2014
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