Provider Demographics
NPI:1730183443
Name:SPRADLIN, ELISA M (MD)
Entity type:Individual
Prefix:DR
First Name:ELISA
Middle Name:M
Last Name:SPRADLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:479-431-3500
Mailing Address - Fax:479-452-2098
Practice Address - Street 1:7003 CHAD COLLEY BLVD
Practice Address - Street 2:
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-3000
Practice Address - Country:US
Practice Address - Phone:479-431-3500
Practice Address - Fax:479-452-2098
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-0503207Q00000X
ARE-1889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K950OtherBLUE CROSS/BLUE SHIELD
6576964003OtherCIGNA
OK200026540AMedicaid
7976182OtherAETNA
AR136209001Medicaid
MS09555297Medicaid
LA1631281Medicaid
P00126582OtherRAILROAD MEDICARE
AR04070022700OtherQUALCHOICE
AR2015989OtherUNITED HEALTHCARE
P00126582OtherRAILROAD MEDICARE
AR5K9507231Medicare PIN