Provider Demographics
NPI:1245279884
Name:DERICK, AMY JANE (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:JANE
Last Name:DERICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:JANE
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1531 S GROVE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5240
Mailing Address - Country:US
Mailing Address - Phone:847-381-8899
Mailing Address - Fax:847-381-8999
Practice Address - Street 1:1531 S GROVE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5240
Practice Address - Country:US
Practice Address - Phone:847-381-8899
Practice Address - Fax:847-381-8999
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36112935207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK29772Medicare PIN
ILP0037690Medicare PIN