Provider Demographics
NPI:1811131527
Name:DENHAM, DAPHNE WATKINS (MD)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:WATKINS
Last Name:DENHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 LAKE COOK RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1447
Mailing Address - Country:US
Mailing Address - Phone:847-559-7702
Mailing Address - Fax:
Practice Address - Street 1:4487 CALICO DR S UNIT B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-9040
Practice Address - Country:US
Practice Address - Phone:701-532-2426
Practice Address - Fax:701-532-2427
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.102521208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery