1528113818 NPI number — DR. ELIZABETH MEDINA COX M.D.

Table of content: DR. ELIZABETH MEDINA COX M.D. (NPI 1528113818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528113818 NPI number — DR. ELIZABETH MEDINA COX M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COX
Provider First Name:
ELIZABETH
Provider Middle Name:
MEDINA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528113818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 ERIC CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE ZURICH
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60047-2781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-732-4264
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 BLANCHARD CIR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WHEATON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60187-1037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-682-0500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 115505800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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