Healthcare Provider Details

I. General information

NPI: 1942646518
Provider Name (Legal Business Name): JOANNE DEBRAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 N AIRLITE ST STE 130
ELGIN IL
60123-4991
US

IV. Provider business mailing address

87 N AIRLITE ST STE 130
ELGIN IL
60123-4991
US

V. Phone/Fax

Practice location:
  • Phone: 847-888-3661
  • Fax: 847-888-9964
Mailing address:
  • Phone: 847-888-3661
  • Fax: 847-888-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-9646
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036141059
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: