Provider Demographics
NPI:1972531549
Name:COLL, DYMPNA A (MD)
Entity Type:Individual
Prefix:DR
First Name:DYMPNA
Middle Name:A
Last Name:COLL
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 1:111 LIONS DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3182
Mailing Address - Country:US
Mailing Address - Phone:847-304-0044
Mailing Address - Fax:847-304-5885
Practice Address - Street 1:111 LIONS DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3182
Practice Address - Country:US
Practice Address - Phone:847-304-0044
Practice Address - Fax:847-304-5885
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102081174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361020811Medicaid
L78941Medicare ID - Type Unspecified
IL0361020811Medicaid