Healthcare Provider Details

I. General information

NPI: 1982437679
Provider Name (Legal Business Name): BAXLEY FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 LAKE COOK RD STE 340
DEERFIELD IL
60015-4933
US

IV. Provider business mailing address

2918 STONEGATE LN
NORTHBROOK IL
60062-4341
US

V. Phone/Fax

Practice location:
  • Phone: 224-258-0826
  • Fax: 847-262-4074
Mailing address:
  • Phone: 617-470-2116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. FRANCES BAXLEY
Title or Position: PHYSICIAN
Credential: MD
Phone: 224-258-0826