Healthcare Provider Details

I. General information

NPI: 1053699140
Provider Name (Legal Business Name): RENAUD DUVAL M.D., F.R.C.S.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2011
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 W 156TH ST SUITE #400
HARVEY IL
60426-4265
US

IV. Provider business mailing address

71 W 156TH ST SUITE #400
HARVEY IL
60426-4265
US

V. Phone/Fax

Practice location:
  • Phone: 708-596-8710
  • Fax: 708-596-9820
Mailing address:
  • Phone: 708-596-8710
  • Fax: 708-596-9820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.127479
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: