Healthcare Provider Details

I. General information

NPI: 1891943619
Provider Name (Legal Business Name): ISIS M DURAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ISIS HIJAZ

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 708-283-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036123529
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036123529
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036123529
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: