Provider Demographics
NPI:1902984149
Name:KOLES, ELENA K (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:K
Last Name:KOLES
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 1:3330 DUNDEE RD STE N5
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2329
Mailing Address - Country:US
Mailing Address - Phone:847-291-0900
Mailing Address - Fax:847-291-9344
Practice Address - Street 1:3330 DUNDEE RD STE N5
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2329
Practice Address - Country:US
Practice Address - Phone:847-291-0900
Practice Address - Fax:847-291-9344
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095112207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211594Medicare ID - Type Unspecified
ILG95363Medicare UPIN