Healthcare Provider Details

I. General information

NPI: 1407215064
Provider Name (Legal Business Name): DURA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 S MICHIGAN AVE SUITE 2500
CHICAGO IL
60603-3357
US

IV. Provider business mailing address

8 S MICHIGAN AVE SUITE 2500
CHICAGO IL
60603-3357
US

V. Phone/Fax

Practice location:
  • Phone: 312-283-3456
  • Fax: 312-380-0153
Mailing address:
  • Phone: 312-283-3456
  • Fax: 312-380-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: NDIDI ONYEJIAKA
Title or Position: ORGANIZER
Credential: M.D.
Phone: 312-283-3456