| Laura Van Dusen M.d. S.c. | |
|
1440 Renaissance Dr Suite 200 Park Ridge IL 60068-1356 | |
| (847) 296-3442 | |
| (847) 296-3543 |
| Full Name | Laura Van Dusen M.d. S.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1440 Renaissance Dr, Park Ridge, Illinois |
| Authorized Official Name and Position | Laura Van Dusen Van Dusen (PRESIDENT) |
| Authorized Official Contact | 8472963442 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Laura Van Dusen M.d. S.c. 1440 Renaissance Dr Suite 200 Park Ridge IL 60068-1356 Ph: (847) 296-3442 | Laura Van Dusen M.d. S.c. 1440 Renaissance Dr Suite 200 Park Ridge IL 60068-1356 Ph: (847) 296-3442 |
| NPI Number | 1790872851 |
|---|---|
| Provider Enumeration Date | 10/09/2006 |
| Last Update Date | 11/07/2010 |
| Medicare PECOS PAC ID | 2264431840 |
|---|---|
| Medicare Enrollment ID | O20061208000102 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790872851 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 036103137 (Illinois) | Primary |
| Provider Name | Laura Marie Vandusen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710072996 PECOS PAC ID: 0941102032 Enrollment ID: I20040121000019 |
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