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Contact Information

DEKALB CLINIC CHARTERED
1850 GATEWAY DR
SYCAMORE, IL60178-3192
 Phone: 815-758-8671
 Fax: 815-758-5610
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Allergy & Immunology

207K00000X 03 Physician/Allergy/ Immunology
 

Cardiovascular Disease

207RC0000X 11 Physician/Internal Medicine
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Dermatology

207N00000X 07 Physician/Dermatology
 

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
 

Mental Health

101YM0800X
 

Ophthalmology

207W00000X 18 Physician/Ophthalmology
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Pulmonary Disease

207RP1001X 11 Physician/Internal Medicine
 

Surgery

208600000X 02 Physician/General Surgery
 

Surgery, Foot & Ankle

213ES0103X 48 Podiatry
 

Urology

208800000X 34 Physician/Urology
 

Wound Care

163WW0000X
Indicates primary specialty

NPI Profile & details for DEKALB CLINIC CHARTERED

NPI Number 1447277140
LBN Legal business name DEKALB CLINIC CHARTERED
Authorized official ROGER HAAB - (CHAIRMAN, BOARD OF DIRECTORS)
Entity Organization
Organization subpart 1 No
Enumeration date 07/17/2006
Last updated 04/30/2013 - About 13 years ago
Identifiers
IL License # 016-005282
IL License # 036119759
IL License # 036120383
IL Other 14D0415284 CLIA #
IL Other 148547 MC INDEPENDENT LAB
IL Other 663680 MEDICARE-GROUP ID
IL Other 1421279 NABP
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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