Provider Demographics
NPI:1740417286
Name:LAREAU, AMANDA S (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:S
Last Name:LAREAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:SILVERIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:525 E CONGRESS PKWY
Mailing Address - Street 2:DERICK DERMATOLOGY SUITE 200
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6245
Mailing Address - Country:US
Mailing Address - Phone:847-381-8899
Mailing Address - Fax:847-381-8999
Practice Address - Street 1:525 E CONGRESS PKWY
Practice Address - Street 2:DERICK DERMATOLOGY SUITE 200
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6245
Practice Address - Country:US
Practice Address - Phone:847-381-8899
Practice Address - Fax:847-381-8999
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-240236207R00000X
IL125059230207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine