Healthcare Provider Details

I. General information

NPI: 1417038043
Provider Name (Legal Business Name): DAVID D. DEUTSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 N MARINE DR SUITE B-5000 GYNECOLOGY
CHICAGO IL
60640-5759
US

IV. Provider business mailing address

1215 W LEXINGTON ST UNIT L
CHICAGO IL
60607-4169
US

V. Phone/Fax

Practice location:
  • Phone: 773-564-5430
  • Fax: 773-564-5431
Mailing address:
  • Phone: 312-666-7180
  • Fax: 312-666-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036061403
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: