Healthcare Provider Details

I. General information

NPI: 1538423371
Provider Name (Legal Business Name): ALLISON HONART WEST DEPERSIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CENTRAL ST. SUITE 610
EVANSTON IL
60201
US

IV. Provider business mailing address

1000 CENTRAL ST. SUITE 610
EVANSTON IL
60201-1780
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-1029
  • Fax: 847-503-4356
Mailing address:
  • Phone: 847-570-1029
  • Fax: 847-503-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number036137170
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036137170
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: