Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036091034 | IL |
NPI | 1235171877 |
---|---|
Provider Name | Jude R Duval |
First Address | Elgin, IL 60121-0357 |
Second Address | Elgin, IL 60123-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036091034 | (05) | IL |
04532078 | BLUECROSS BLUESHIELD (01) | IL |
1821256355 | NPI FOR MATERNAL FETAL CONSULTANTS, SC (01) | IL |
G15398 | (02) | IL |