MEDICARE: DR. DEREK C ARCHER 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	2085B0100X	Body Imaging Physician	36084401	IL

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	:	1629164256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK C ARCHER M.D.

Provider Business Mailing Address
First Line	:	410 ROSEMARY RD
Second Line	:
City	:	TORONTO
State	:	ONTARIO
Zip	:	M5P 3E5
Country	:	CA
Telephone Number	:	416-617-0102
Fax Number	:

Provider Business Practice Location Address
First Line	:	22N285 PEPPER RD
Second Line	:	SUITE #103
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-5982
Country	:	US
Telephone Number	:	847-732-2739
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/18/2008

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