Individual
ELYSE FULTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1653 W CONGRESS PKWY, CHICAGO, IL 60612-3833
(312) 942-0229
Mailing address
1653 W CONGRESS PKWY, CHICAGO, IL 60612-3833
(312) 942-0229
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036165474
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/13/2019
Last updated
06/27/2023
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