Provider Demographics
NPI:1902989106
Name:FOX VALLEY DERMATOLOGY, LTD.
Entity Type:Organization
Organization Name:FOX VALLEY DERMATOLOGY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REMLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-236-4257
Mailing Address - Street 1:6476 NEW ALBANY RD
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3237
Mailing Address - Country:US
Mailing Address - Phone:630-536-8552
Mailing Address - Fax:630-536-8553
Practice Address - Street 1:2972 INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9408
Practice Address - Country:US
Practice Address - Phone:630-236-4257
Practice Address - Fax:630-236-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210785Medicare PIN