Provider Demographics
NPI:1407012743
Name:VALASSIS, PATRICIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:J
Last Name:VALASSIS
Suffix:
Gender:F
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 RAYMOND DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9789
Mailing Address - Country:US
Mailing Address - Phone:630-717-2300
Mailing Address - Fax:
Practice Address - Street 1:946 N NELTNOR BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-5959
Practice Address - Country:US
Practice Address - Phone:630-717-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-126009208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036126009Medicaid
IL036126009Medicaid
IL0727500008Medicare NSC