Organization
DEKALB CLINIC CHARTERED
Active
Organization
DEKALB CLINIC CHARTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER L HAAB M.D. (CHAIRMAN, BOARD OF DIRECTORS)
(815) 758-8671
Entity
Organization
Contact information
Practice address
1850 GATEWAY DR, SYCAMORE, IL 60178-3192
(815) 758-8671
(815) 758-5610
Mailing address
1850 GATEWAY DR, SYCAMORE, IL 60178-3192
(815) 758-8671
(815) 758-5610
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
133V00000X
Registered Dietitian
—
IL
163WW0000X
Wound Care Registered Nurse
—
—
207K00000X
Allergy & Immunology Physician
—
—
207N00000X
Dermatology Physician
036119759
IL
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
IL
207W00000X
Ophthalmology Physician
036120383
IL
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
016-005282
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1421279
NABP
IL
01
—
148547
MC INDEPENDENT LAB
IL
01
—
14D0415284
CLIA #
IL
01
—
663680
MEDICARE-GROUP ID
IL
Enumeration date
07/17/2006
Last updated
04/30/2013
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