Provider Demographics
NPI:1356423651
Name:ALLEN, VIRGINIA THERESE (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:THERESE
Last Name:ALLEN
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 1:1S224 SUMMIT AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3983
Mailing Address - Country:US
Mailing Address - Phone:630-953-1190
Mailing Address - Fax:630-953-1102
Practice Address - Street 1:1S224 SUMMIT AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3983
Practice Address - Country:US
Practice Address - Phone:630-953-1190
Practice Address - Fax:630-953-1102
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-084775207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL593780OtherMEDICARE GROUP
1962897629OtherGROUP NPI
2210832OtherBCBS ID
IL593780OtherMEDICARE GROUP
ILF31351Medicare UPIN
IL1356423651Medicare NSC