Provider Demographics
NPI:1316279441
Name:REBECCA J DUKE MD PC
Entity type:Organization
Organization Name:REBECCA J DUKE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-202-7703
Mailing Address - Street 1:3929 N CENTRAL AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3072
Mailing Address - Country:US
Mailing Address - Phone:773-202-7703
Mailing Address - Fax:773-202-7708
Practice Address - Street 1:3929 N CENTRAL AVE
Practice Address - Street 2:STE 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3072
Practice Address - Country:US
Practice Address - Phone:773-202-7703
Practice Address - Fax:773-202-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079316174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079316Medicaid
ILB47963Medicare UPIN
IL036079316Medicaid