ELEMENTAL MEDICAL CENTER LTD NPI 1164935169

NPI Information

  • NPI: 1164935169
  • Provider Name: ELEMENTAL MEDICAL CENTER LTD
  • Classification: Psychiatry & Neurology - 2084P0804X
  • Specialization: Child & Adolescent Psychiatry
  • Entity Type: Organization
  • Address: 612 S WESTERN AVE APT 1
    CHICAGO, IL
    ZIP 60612
  • Phone: (331) 330-9955

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NPI Details

ELEMENTAL MEDICAL CENTER LTD is a child and adolescent psychiatry psychiatry neurology in Chicago, IL. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. ELEMENTAL MEDICAL CENTER LTD NPI is 1164935169. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

612 S WESTERN AVE APT 1
CHICAGO, IL
ZIP 60612-682
Phone: (331) 330-9955
Fax: (708) 892-2909

The provider's authorized official is Martins A Adeoye .
The authorized official title is Ceo and has the following contact phone number (331) 330-9955.

The enumeration date for this NPI number is 11/13/2017 and was last updated on 10/22/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12084P0804XPsychiatry & NeurologyChild & Adolescent Psychiatry036103889ILLINOISYes
2261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1036103889MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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