Basic Information
| Provider Information | |||||||||
| NPI: | 1225019474 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DURBIN | ||||||||
| FirstName: | EUGENE | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 N POPLAR ST | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450561204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135232111 | ||||||||
| FaxNumber: | 5135240144 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 REMITTANCE DR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606756508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144422400 | ||||||||
| FaxNumber: | 6144422403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 02/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 35-054602 | OH | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 0867629 | 05 | OH | MEDICAID |