Douglas Foulke, M.D.
Individual provider Active NPI Emergency Medicine Physician · Chicago, IL
NPI 1467477992 · NPPES record last updated Dec 23, 2009
Key facts
- NPI
- 1467477992
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 036-059577 (IL)
- Practice address
- 6121 N Hermitage Ave
Chicago, IL 60660-2305 - Phone
- (773) 973-3005
- Fax
- (773) 973-3006
- NPI assigned
- Jul 13, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35104 | CO | MD | Emergency Medicine Physician |
| 036-059577 | IL | MD | Emergency Medicine Physician |
| 01051286 | IN | MD | Emergency Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 35104 | CO | |
| Emergency Medicine Physician | 207P00000X | 036-059577 | IL | Yes |
| Emergency Medicine Physician | 207P00000X | 01051286 | IN |
Addresses
Primary practice location
6121 N Hermitage Ave
Chicago, IL 60660-2305
Mailing address
6121 N Hermitage Ave
Chicago, IL 60660-2305
Phone (773) 973-3005
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036059577 | Medicaid | IL |
Other providers in Chicago, IL
- Laura Fouad
- Leila Zineb Foudil
- Anisa Elizabeth Fought-Boudaia
- Anthony O Foulen
- Eric Sean Fouliard
- Oussama Founas
- Foundation for Emergency Services
- Foundation for Emergency Services
- Foundation for Outreach Services
- Foundation Physical Therapy LLC
All providers in Chicago, IL · Emergency Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.