MEDICARE: DR. AMY JANE DERICK M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	36112935	IL

General Provider Information

NPI Number	:	1245279884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY JANE DERICK M.D

Provider Business Mailing Address
First Line	:	1531 S GROVE AVE
Second Line	:	SUITE 101
City	:	BARRINGTON
State	:	IL
Zip	:	60010-5240
Country	:	US
Telephone Number	:	847-381-8899
Fax Number	:	847-381-8999

Provider Business Practice Location Address
First Line	:	1531 S GROVE AVE
Second Line	:	SUITE 101
City	:	BARRINGTON
State	:	IL
Zip	:	60010-5240
Country	:	US
Telephone Number	:	847-381-8899
Fax Number	:	847-381-8999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	12/16/2021

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