Provider Demographics
NPI:1891943619
Name:DURAN, ISIS M (MD)
Entity type:Individual
Prefix:DR
First Name:ISIS
Middle Name:M
Last Name:DURAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ISIS
Other - Middle Name:
Other - Last Name:HIJAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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 1:4440 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-283-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123529174400000X, 2084N0400X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No174400000XOther Service ProvidersSpecialist
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036123529OtherSTATE LICENSE
IL036123529Medicaid
IL206147OtherMEDICARE PTAN (GROUP)
IL206147067OtherMEDICARE PTAN (INDIVIDUAL)
ILP00974077OtherMEDICARE RAILROAD PTAN