Individual
ELIO BETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2160 S 1ST AVE, BLDG 110 ROOM 3210, MAYWOOD, IL 60153-3328
(708) 216-9000
(708) 216-9000
Mailing address
2160 S 1ST AVE, BLDG 110 ROOM 3210, MAYWOOD, IL 60153-3328
(708) 216-9000
(708) 216-9000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036143123
IL
208600000X
Surgery Physician
125.061813
IL
Other
Enumeration date
03/26/2012
Last updated
05/31/2022
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