Individual
DR. DOUG VALASSIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2650 RIDGE AVE, EMERGENCY MEDICINE, EVANSTON, IL 60201-1718
(847) 570-2114
(847) 570-1223
Mailing address
2650 RIDGE AVE, PROFESSIONAL STAFF OFFICE, EVANSTON, IL 60201-1718
(847) 570-2040
(847) 733-5315
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036136990
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036136990
STATE LICENSE
IL
Enumeration date
05/08/2012
Last updated
08/31/2016
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