Individual
ELI LAVIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2151 WAUKEGAN RD, SUITE 100, BANNOCKBURN, IL 60015-1885
(847) 444-5300
(847) 267-0694
Mailing address
2151 WAUKEGAN RD, SUITE 100, BANNOCKBURN, IL 60015-1885
(847) 444-5300
(847) 267-0694
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
36077799
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04915267
BLUE CROSS BLUE SHIELD
IL
01
—
060061877
RAILROAD MEDICARE
IL
05
—
36077799
—
IL
01
—
K05845
MEDICARE PIN LOCALITY 16
IL
01
—
L84678
MEDICARE PIN LOCALITY 15
IL
Enumeration date
07/16/2006
Last updated
12/08/2020
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