Healthcare Provider Details

I. General information

NPI: 1588730501
Provider Name (Legal Business Name): TONY FU MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 CHURCH ST STE 222
EVANSTON IL
60201
US

IV. Provider business mailing address

636 CHURCH ST STE 222
EVANSTON IL
60201
US

V. Phone/Fax

Practice location:
  • Phone: 847-328-3913
  • Fax: 847-328-3952
Mailing address:
  • Phone: 847-328-3913
  • Fax: 847-328-3952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number3648697
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number3648697
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number3648697
License Number StateIL

VIII. Authorized Official

Name: DR. TONY S FU
Title or Position: PRESIDENT
Credential: MD
Phone: 847-328-3913