Healthcare Provider Details

I. General information

NPI: 1366431504
Provider Name (Legal Business Name): DEBORAH JEANNE GALEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH J GALEN M.D.

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 SAMPSON ST FISHER CLINIC, BLDG 237
GREAT LAKES IL
60088-2942
US

IV. Provider business mailing address

321 INDIAN HILL DR
BUFFALO GROVE IL
60089-1902
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-5556
  • Fax: 847-688-2512
Mailing address:
  • Phone: 847-688-5556
  • Fax: 847-688-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: