Provider Demographics
NPI:1669604625
Name:DUARTE, JOSE G (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:G
Last Name:DUARTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:197 N LARCH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2724
Mailing Address - Country:US
Mailing Address - Phone:630-667-7726
Mailing Address - Fax:630-530-4717
Practice Address - Street 1:197 N LARCH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2724
Practice Address - Country:US
Practice Address - Phone:630-667-7726
Practice Address - Fax:630-530-4717
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-052007207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-052007OtherANESTHESIOLOGY