MEDICARE: MEDFUSE ILLINOIS PLLC

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	261QI0500X	Infusion Therapy Clinic/Center
2	208D00000X	General Practice Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558123257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDFUSE ILLINOIS PLLC

Provider Business Mailing Address
First Line	:	4711 GOLF RD STE 900
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1247
Country	:	US
Telephone Number	:	847-324-6800
Fax Number	:	224-251-7141

Provider Business Practice Location Address
First Line	:	4711 GOLF RD STE 900
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1247
Country	:	US
Telephone Number	:	847-324-6800
Fax Number	:	224-251-7141

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MATTHEW DUBE
Credential	:	MD
Telephone Number	:	773-383-2042

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	03/20/2026

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