Provider Demographics
NPI:1386641751
Name:DUBOE, FRED J (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:J
Last Name:DUBOE
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 1:1786 MOON LAKE BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-5029
Mailing Address - Country:US
Mailing Address - Phone:847-884-1800
Mailing Address - Fax:847-884-6768
Practice Address - Street 1:1786 MOON LAKE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-5029
Practice Address - Country:US
Practice Address - Phone:847-884-1800
Practice Address - Fax:847-884-6768
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063641207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063641Medicaid
ILC44929Medicare UPIN
IL363140Medicare ID - Type Unspecified