Provider Demographics
NPI:1992298293
Name:MEDICAL DIRECTOR ON DEMAND LLC
Entity type:Organization
Organization Name:MEDICAL DIRECTOR ON DEMAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MA
Authorized Official - Phone:312-965-0499
Mailing Address - Street 1:47 W. POLK STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605
Mailing Address - Country:US
Mailing Address - Phone:312-427-0774
Mailing Address - Fax:312-427-0775
Practice Address - Street 1:47 W. POLK STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605
Practice Address - Country:US
Practice Address - Phone:312-427-0774
Practice Address - Fax:312-427-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-169074163W00000X
IL036.115000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty