Provider Demographics
NPI:1932260080
Name:DURHAM, JOSEPH R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:DURHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10347S LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2610
Mailing Address - Country:US
Mailing Address - Phone:773-206-7197
Mailing Address - Fax:773-238-9608
Practice Address - Street 1:1 INGALLS DRIVE
Practice Address - Street 2:LL NORTH BLDG
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:708-915-5585
Practice Address - Fax:708-915-5589
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360642312086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL770003033OtherPALMETTO RR MEDICARE
ILK48135Medicare PIN
IL770003033OtherPALMETTO RR MEDICARE