Provider Demographics
NPI:1104058379
Name:DUQUE, KRISTIN S (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:S
Last Name:DUQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2233 W DIVISION ST
Mailing Address - Street 2:2ND FLOOR CARDIOLOGY DEPARTMENT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8151
Mailing Address - Country:US
Mailing Address - Phone:312-770-2385
Mailing Address - Fax:312-770-2531
Practice Address - Street 1:2233 W DIVISION ST
Practice Address - Street 2:2ND FLOOR CARDIOLOGY DEPARTMENT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-8151
Practice Address - Country:US
Practice Address - Phone:312-770-2385
Practice Address - Fax:312-770-2531
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-104337207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104337Medicaid
IL036104337Medicaid