1609018803 NPI number — OLGA DUCHON M.D.

Table of content: OLGA DUCHON M.D. (NPI 1609018803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609018803 NPI number — OLGA DUCHON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUCHON
Provider First Name:
OLGA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TATYANENKO
Provider Other First Name:
OLHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609018803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 E IL ROUTE 83 STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNDELEIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60060-4278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
242-585-9559
Provider Business Mailing Address Fax Number:
978-506-2201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 E IL ROUTE 83 STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNDELEIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60060-4278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-585-9559
Provider Business Practice Location Address Fax Number:
978-506-2201
Provider Enumeration Date:
04/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  036131206 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 036131206 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 036131206 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036131206 . This is a "STATE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".