Provider Demographics
NPI:1558123257
Name:MEDFUSE ILLINOIS PLLC
Entity Type:Organization
Organization Name:MEDFUSE ILLINOIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-383-2042
Mailing Address - Street 1:4711 GOLF RD STE 900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1247
Mailing Address - Country:US
Mailing Address - Phone:847-324-6800
Mailing Address - Fax:224-251-7141
Practice Address - Street 1:4711 GOLF RD STE 900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1247
Practice Address - Country:US
Practice Address - Phone:847-324-6800
Practice Address - Fax:224-251-7141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy