Provider Demographics
NPI:1871784553
Name:ADATYA, ELISSA KIM (MD)
Entity type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:KIM
Last Name:ADATYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:D
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1333 BUTTERFIELD RD
Mailing Address - Street 2:STE 130
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5607
Mailing Address - Country:US
Mailing Address - Phone:630-371-0133
Mailing Address - Fax:630-371-0138
Practice Address - Street 1:1333 BUTTERFIELD RD
Practice Address - Street 2:STE 130
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5607
Practice Address - Country:US
Practice Address - Phone:630-371-0133
Practice Address - Fax:630-371-0138
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036136928207R00000X
MN55534207R00000X
CT048846208M00000X, 207R00000X
NY246976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist