Provider Demographics
NPI:1891865515
Name:DULCAN, MINA K (MD)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:K
Last Name:DULCAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 EAST CHICAGO AVE. BOX 10
Mailing Address - Street 2:ANN & ROBERT H. LURIE CHILDRENS HOSPITAL OF CHICAGO
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2605
Mailing Address - Country:US
Mailing Address - Phone:312-227-3413
Mailing Address - Fax:
Practice Address - Street 1:225 EAST CHICAGO AVE. BOX 10
Practice Address - Street 2:ANN & ROBERT H. LURIE CHILDRENS HOSPITAL OF CHICAGO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2605
Practice Address - Country:US
Practice Address - Phone:312-227-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360876742084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087674Medicaid