Healthcare Provider Details

I. General information

NPI: 1699878470
Provider Name (Legal Business Name): KATHERINE DUVALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

835 S WOLCOTT AVE RM E144
CHICAGO IL
60612-3748
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 312-996-7420
  • Fax: 312-413-8485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number036079810
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: