Provider Demographics
NPI:1043383524
Name:FU, TONY S (MD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:S
Last Name:FU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 CHURCH ST STE 222
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4578
Mailing Address - Country:US
Mailing Address - Phone:847-328-3913
Mailing Address - Fax:847-328-3952
Practice Address - Street 1:636 CHURCH ST STE 222
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4578
Practice Address - Country:US
Practice Address - Phone:847-328-3913
Practice Address - Fax:847-328-3952
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3648697207N00000X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25792Medicare PIN
ILC42575Medicare UPIN
ILK25791Medicare PIN