MEDICARE: DR. PATRICIA J VALASSIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036-126009	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407012743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA J VALASSIS M.D.

Provider Business Mailing Address
First Line	:	636 RAYMOND DR
Second Line	:	SUITE 205
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-9789
Country	:	US
Telephone Number	:	630-717-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	946 N NELTNOR BLVD
Second Line	:	SUITE 120
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-5959
Country	:	US
Telephone Number	:	630-717-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	11/15/2013

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