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Organization

ELISABETH AV DESAPEREIRA,MD,LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ELISABETH A V DESAPEREIRA M.D. (PRESIDENT)
(847) 389-5930
Entity
Organization

Contact information

Practice address
1117 S MILWAUKEE AVE, SUITE B8, LIBERTYVILLE, IL 60048-3798
(847) 281-9990
(847) 295-0293
Mailing address
3018 PARKSIDE DR, HIGHLAND PARK, IL 60035-1067
(847) 433-0057
(847) 432-2174

Taxonomy

Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036049974
IL
Enumeration date
10/26/2006
Last updated
08/08/2008
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