Basic Information
| Provider Information | |||||||||
| NPI: | 1205846128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLIVEROS | ||||||||
| FirstName: | DESIREE | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OLIVEROS | ||||||||
| OtherFirstName: | C. DESIREE | ||||||||
| OtherMiddleName: | F | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1000 REMINGTON BLVD | ||||||||
| Address2: | SUITE 100 - (ATTN: MELVONNE JONES) | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604405114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309142417 | ||||||||
| FaxNumber: | 6309142469 | ||||||||
| Practice Location | |||||||||
| Address1: | 1975 LIN LOR LANE | ||||||||
| Address2: | SUITE 295 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601230000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476222086 | ||||||||
| FaxNumber: | 8476085281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 03/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-112400 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036.112400 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.