Provider Demographics
NPI:1750436952
Name:FEROLO, RICHARD J (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:FEROLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22285 PEPPER ROAD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010
Mailing Address - Country:US
Mailing Address - Phone:847-277-9700
Mailing Address - Fax:847-277-9708
Practice Address - Street 1:22285 N PEPPER RD STE 211
Practice Address - Street 2:
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2540
Practice Address - Country:US
Practice Address - Phone:847-277-9700
Practice Address - Fax:847-277-9708
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071510174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK44414Medicare PIN