Provider Demographics
NPI:1609018803
Name:DUCHON, OLGA (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:DUCHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLHA
Other - Middle Name:
Other - Last Name:TATYANENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:333 E IL ROUTE 83 STE 100
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-4278
Mailing Address - Country:US
Mailing Address - Phone:242-585-9559
Mailing Address - Fax:978-506-2201
Practice Address - Street 1:333 E IL ROUTE 83 STE 100
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-4278
Practice Address - Country:US
Practice Address - Phone:224-585-9559
Practice Address - Fax:978-506-2201
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131206208M00000X, 207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036131206OtherSTATE LICENSE