Provider Demographics
NPI:1780908178
Name:FOX VALLEY IMMEDIATE CARE CENTER, LTD
Entity type:Organization
Organization Name:FOX VALLEY IMMEDIATE CARE CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:TUEMGNE
Authorized Official - Last Name:FOTSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-909-2590
Mailing Address - Street 1:151 DUNDEE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1648
Mailing Address - Country:US
Mailing Address - Phone:847-426-9396
Mailing Address - Fax:847-426-1086
Practice Address - Street 1:151 DUNDEE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-1648
Practice Address - Country:US
Practice Address - Phone:847-426-9396
Practice Address - Fax:847-426-1086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty