| Dardur Medical Group | |
|
19150 Kedzie Ave Ste 100 Homewood IL 60430-4540 | |
| (312) 487-1058 | |
| Not Available |
| Full Name | Dardur Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 19150 Kedzie Ave Ste 100, Homewood, Illinois |
| Authorized Official Name and Position | Taiwo F Durowade (OB/GYN) |
| Authorized Official Contact | 3124871058 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dardur Medical Group 1831 218th Pl Sauk Village IL 60411-4914 Ph: (309) 750-2638 | Dardur Medical Group 19150 Kedzie Ave Ste 100 Homewood IL 60430-4540 Ph: (312) 487-1058 |
| NPI Number | 1518583210 |
|---|---|
| Provider Enumeration Date | 06/18/2020 |
| Last Update Date | 10/28/2021 |
| Certification Date | 10/28/2021 |
| Medicare PECOS PAC ID | 2466871769 |
|---|---|
| Medicare Enrollment ID | O20201007000093 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518583210 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 207V00000X | Obstetrics & Gynecology | () | Secondary |
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Taiwo F. Durowade |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1427391168 PECOS PAC ID: 4981977303 Enrollment ID: I20170907000996 |
| Provider Name | Amani Muhammad Johnson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1558136390 PECOS PAC ID: 8527506682 Enrollment ID: I20240820003286 |
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