MEDICARE: MISS JUSTYNE DOMINIQUE CHERISSE DUBERRY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207L00000X	Anesthesiology Physician	125.084890	IL

General Provider Information

NPI Number	:	1114762606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JUSTYNE DOMINIQUE CHERISSE DUBERRY M.D.

Provider Business Mailing Address
First Line	:	JOHN H STROGER HOSPITAL OF COOK COUNTY HEALTH, GME
Second Line	:	1950 W POLK ST, SUITE 5210
City	:	CHICAGO
State	:	IL
Zip	:	60612-1833
Country	:	US
Telephone Number	:	312-864-1905
Fax Number	:

Provider Business Practice Location Address
First Line	:	JOHN H STROGER HOSPITAL OF COOK COUNTY HEALTH, GME
Second Line	:	1950 W POLK ST, SUITE 5210
City	:	CHICAGO
State	:	IL
Zip	:	60612-1833
Country	:	US
Telephone Number	:	312-864-1905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	09/14/2024

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