Provider Demographics
NPI:1336137207
Name:DERKEN, LISA F (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:F
Last Name:DERKEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:F
Other - Last Name:RICKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 FOX GLEN DR
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1824
Practice Address - Country:US
Practice Address - Phone:847-382-9150
Practice Address - Fax:847-382-9155
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095963Medicaid
IL036095963Medicaid
G83115Medicare UPIN