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NPI Code Detail

MEDICARE: FOX VALLEY DERMATOLOGY, LTD.

MEDICARE: FOX VALLEY DERMATOLOGY, LTD.
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
1261QM2500XMedical Specialty Clinic/CenterIL

General Provider Information

NPI Number : 1902989106
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOX VALLEY DERMATOLOGY, LTD.
Provider Business Mailing Address
First Line : 6476 NEW ALBANY RD
Second Line :
City : LISLE
State : IL
Zip : 60532-3237
Country : US
Telephone Number : 630-536-8552
Fax Number : 630-536-8553
Provider Business Practice Location Address
First Line : 2972 INDIAN TRAIL RD
Second Line :
City : AURORA
State : IL
Zip : 60502-9408
Country : US
Telephone Number : 630-236-4257
Fax Number : 630-236-4241
Authorized Official
Title or Position : PRESIDENT
Name : KATHLEEN ANN REMLINGER
Credential : M.D.
Telephone Number : 630-236-4257
Provider Enumeration Date : 10/23/2006
Last Update Date : 11/30/2007

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