Provider Demographics
NPI:1053418350
Name:DISAVINO, ELIA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:ELIA
Middle Name:MARIA
Last Name:DISAVINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3718
Mailing Address - Country:US
Mailing Address - Phone:630-321-9951
Mailing Address - Fax:
Practice Address - Street 1:JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY
Practice Address - Street 2:1901 W. HARRISON ST.
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1066312084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL26294OtherPROVIDER ID OR MRAN#