Basic Information
| Provider Information | |||||||||
| NPI: | 1396069191 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUER | ||||||||
| FirstName: | CHARLOTTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 RAND RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600162359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473243976 | ||||||||
| FaxNumber: | 8479291154 | ||||||||
| Practice Location | |||||||||
| Address1: | 9000 WAUKEGAN RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MORTON GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600532127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473753000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2010 | ||||||||
| LastUpdateDate: | 06/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.