Healthcare Provider Details

I. General information

NPI: 1508071010
Provider Name (Legal Business Name): VIOLETA P DULANAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4958 W MADISON ST
CHICAGO IL
60644-3541
US

IV. Provider business mailing address

3910 N OCONTO AVE
CHICAGO IL
60634-3509
US

V. Phone/Fax

Practice location:
  • Phone: 312-746-4870
  • Fax: 312-746-4637
Mailing address:
  • Phone: 773-589-9295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: