Provider Demographics
NPI:1538313705
Name:FUGALI, VALERIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIA
Middle Name:
Last Name:FUGALI
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 1:1807 N MOHAWK ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5213
Mailing Address - Country:US
Mailing Address - Phone:312-543-3065
Mailing Address - Fax:
Practice Address - Street 1:1807 N MOHAWK ST
Practice Address - Street 2:UNIT B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5213
Practice Address - Country:US
Practice Address - Phone:312-543-3065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059935207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology