Provider Demographics
NPI:1710191705
Name:DEY, LUCY (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:
Last Name:DEY
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 1:202 N HAMMES AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8136
Mailing Address - Country:US
Mailing Address - Phone:815-714-2240
Mailing Address - Fax:815-582-3597
Practice Address - Street 1:330 MADISON ST
Practice Address - Street 2:SUITE 303
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6565
Practice Address - Country:US
Practice Address - Phone:815-714-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112067207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00436347/CK6882OtherRR MEDICARE
IL4673170001OtherDMERC
IL4673170001OtherDMERC