Basic Information
| Provider Information | |||||||||
| NPI: | 1548256746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UNGARETTI | ||||||||
| FirstName: | DARI ANN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 OAKMONT LN | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605595511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307892550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1710 N RANDALL RD | ||||||||
| Address2: | SUITE 380 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601239400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477421000 | ||||||||
| FaxNumber: | 8477421144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 03/10/2009 | ||||||||
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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 | 207N00000X | 036097381 | IL | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | P00611330 | 01 | IL | RAILROAD MEDICARE | OTHER | 036097381 | 05 | IL | MEDICAID | 070016282 | 01 | IL | RAILROAD MEDICARE | OTHER | 04530336 | 01 | IL | BCBS PROVIDER ID | OTHER |