Individual
MRS. DOMINNO CAROLINE FOGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.M.S., PA-C
Contact information
Practice address
21660 W FIELD PKWY, DEER PARK, IL 60010-7265
(888) 803-3370
Mailing address
271 COUNTY ROAD 2325 E, CARLOCK, IL 61725-9020
(815) 931-0244
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085004161
IL
Other
Enumeration date
10/07/2011
Last updated
06/10/2024
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