Provider Demographics
NPI:1205928405
Name:DUCHON, JEFFREY HOWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HOWARD
Last Name:DUCHON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5191
Mailing Address - Country:US
Mailing Address - Phone:773-489-0565
Mailing Address - Fax:773-489-0575
Practice Address - Street 1:2052 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5191
Practice Address - Country:US
Practice Address - Phone:773-489-0565
Practice Address - Fax:773-489-0575
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist