Provider Demographics
NPI:1235171877
Name:DUVAL, JUDE R (MD)
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:R
Last Name:DUVAL
Suffix:
Gender:M
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 357
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60121-0357
Mailing Address - Country:US
Mailing Address - Phone:224-783-8975
Mailing Address - Fax:630-762-9681
Practice Address - Street 1:1425 N RANDALL RD STE 1-2150
Practice Address - Street 2:MATERNAL FETAL CONSULTANTS, SC
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2300
Practice Address - Country:US
Practice Address - Phone:224-783-8975
Practice Address - Fax:630-762-9681
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091034207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532078OtherBLUECROSS BLUESHIELD
IL036091034Medicaid
IL1821256355OtherNPI FOR MATERNAL FETAL CONSULTANTS, SC
IL212564Medicare PIN
ILG15398Medicare UPIN