Provider Demographics
NPI:1023121662
Name:STICH, DUANE DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DUANE
Middle Name:DAVID
Last Name:STICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-723-2338
Practice Address - Street 1:1775 DEMPSTER ST
Practice Address - Street 2:DEPT. OF NEONATOLOGY 2 SOUTH
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:847-723-5313
Practice Address - Fax:847-723-2338
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI48209-0202080N0001X
IL036-1065622080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-106562Medicaid
WI34658700Medicaid