Healthcare Provider Details

I. General information

NPI: 1225194681
Provider Name (Legal Business Name): DAISY M FELARCA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N COUNTY FARM RD
WHEATON IL
60187
US

IV. Provider business mailing address

186 BRIARWOOD CT
ELGIN IL
60120-4778
US

V. Phone/Fax

Practice location:
  • Phone: 630-682-7979
  • Fax:
Mailing address:
  • Phone: 847-695-3946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number036-067763
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: