Basic Information
| Provider Information | |||||||||
| NPI: | 1821053851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUES | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 3118 E 10TH ST STE A | ||||||||
| Address2: | |||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471305904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122826979 | ||||||||
| FaxNumber: | 8122826998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 03/20/2019 | ||||||||
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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 | 207R00000X | 30488 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01045680A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110138274 | 01 | IN | RRMCR | OTHER | 8118208002 | 01 | CIGNA / NCMA | OTHER | 000023934B | 01 | HUMANA / NCMA | OTHER | 1193931 | 01 | CHA / NCMA | OTHER | 200123480 | 05 | IN | MEDICAID | 00000050971 | 01 | ANTHEM - NCMA | OTHER | 2447472000 | 01 | PAD - NCMA | OTHER | 002270 | 01 | SIHO - NCMA | OTHER | 50006204 | 01 | PASSPORT - NCMA | OTHER |