| Elemental Medical Center Ltd | |
|
612 S Western Ave Apt 1 Chicago IL 60612-4682 | |
| (331) 330-9955 | |
| (708) 892-2909 |
| Full Name | Elemental Medical Center Ltd |
|---|---|
| Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
| Location | 612 S Western Ave Apt 1, Chicago, Illinois |
| Authorized Official Name and Position | Martins A Adeoye (CEO) |
| Authorized Official Contact | 3313309955 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elemental Medical Center Ltd 15010 S Ravinia Ave Ste 15 Orland Park IL 60462-5353 Ph: (331) 330-9955 | Elemental Medical Center Ltd 612 S Western Ave Apt 1 Chicago IL 60612-4682 Ph: (331) 330-9955 |
| NPI Number | 1164935169 |
|---|---|
| Provider Enumeration Date | 11/13/2017 |
| Last Update Date | 10/22/2024 |
| Certification Date | 10/22/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164935169 | NPI | - | NPPES |
| 036103889 | Medicaid | IL |
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