Provider Demographics
NPI:1790945905
Name:DEUTCH, TODD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:DAVID
Last Name:DEUTCH
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 1:2252 TENNYSON LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1640
Mailing Address - Country:US
Mailing Address - Phone:847-748-8566
Mailing Address - Fax:
Practice Address - Street 1:435 N MULFORD RD
Practice Address - Street 2:SUITE 9
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5189
Practice Address - Country:US
Practice Address - Phone:815-229-1700
Practice Address - Fax:815-229-1831
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111547207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology