Provider Demographics
NPI:1114762606
Name:DUBERRY, JUSTYNE DOMINIQUE CHERISSE (MD)
Entity type:Individual
Prefix:MISS
First Name:JUSTYNE
Middle Name:DOMINIQUE CHERISSE
Last Name:DUBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:JOHN H STROGER HOSPITAL OF COOK COUNTY HEALTH, GME
Mailing Address - Street 2:1950 W POLK ST, SUITE 5210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1833
Mailing Address - Country:US
Mailing Address - Phone:312-864-1905
Mailing Address - Fax:
Practice Address - Street 1:JOHN H STROGER HOSPITAL OF COOK COUNTY HEALTH, GME
Practice Address - Street 2:1950 W POLK ST, SUITE 5210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1833
Practice Address - Country:US
Practice Address - Phone:312-864-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125.084890207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program