Provider Demographics
NPI:1073826715
Name:DUCTAN, KERLINE (MD)
Entity Type:Individual
Prefix:
First Name:KERLINE
Middle Name:
Last Name:DUCTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5451
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60204
Mailing Address - Country:US
Mailing Address - Phone:786-303-3676
Mailing Address - Fax:
Practice Address - Street 1:1300 FRANKLIN AVE STE 380
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4266
Practice Address - Country:US
Practice Address - Phone:309-268-3598
Practice Address - Fax:309-268-2536
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-131088208M00000X, 207R00000X
IL125057835207R00000X
WI61250208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist