Provider Demographics
NPI:1598059354
Name:DEROUIN, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:DEROUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:DEROUIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:2357 HASSELL RD STE 210
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2172
Mailing Address - Country:US
Mailing Address - Phone:847-985-8380
Mailing Address - Fax:847-985-9475
Practice Address - Street 1:2357 HASSELL RD STE 210
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2172
Practice Address - Country:US
Practice Address - Phone:847-985-8380
Practice Address - Fax:847-985-9475
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005456213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery