Healthcare Provider Details

I. General information

NPI: 1518950567
Provider Name (Legal Business Name): METE A DURUM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6947 DEMPSTER ST
MORTON GROVE IL
60053-2021
US

IV. Provider business mailing address

1000 BURR RIDGE PKWY STE 200
BURR RIDGE IL
60527-0845
US

V. Phone/Fax

Practice location:
  • Phone: 630-920-4670
  • Fax: 630-920-4687
Mailing address:
  • Phone: 630-920-4670
  • Fax: 630-920-4687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038-006125
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: