Provider Demographics
NPI:1568765360
Name:DAVID D DEUTSCH MD PC LTD
Entity Type:Organization
Organization Name:DAVID D DEUTSCH MD PC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HWEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-564-5430
Mailing Address - Street 1:1215 W LEXINGTON ST
Mailing Address - Street 2:UNIT L
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4169
Mailing Address - Country:US
Mailing Address - Phone:773-564-5430
Mailing Address - Fax:773-564-5431
Practice Address - Street 1:4646 N MARINE DR
Practice Address - Street 2:SUITE #B5000
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5759
Practice Address - Country:US
Practice Address - Phone:773-564-5430
Practice Address - Fax:773-564-5431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061403Medicaid
IL036061403Medicaid