Active NPI
Jose Dutra, MD
- Otolaryngology Physician
- Chicago, IL
National Provider Identifier
1760418768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 036102537
- Practice address
- 675 N Saint Clair St
Galter 15-200
Chicago, IL 60611-5975 - Phone
- (312) 695-8182
- Fax
- (312) 695-7851
- NPI assigned
- Jun 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 036102537 | IL | Primary |
Addresses
Primary practice location
675 N Saint Clair St
Galter 15-200
Chicago, IL 60611-5975
Mailing address
680 N Lake Shore Dr
Suite 1000
Chicago, IL 60611-4546
Phone (312) 695-8182
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036102537 | IL | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246320000000",
"number": "1760418768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "680 N LAKE SHORE DR",
"address_2": "SUITE 1000",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606114546",
"telephone_number": "312-695-8182",
"fax_number": "312-695-7851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "675 N SAINT CLAIR ST",
"address_2": "GALTER 15-200",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606115975",
"telephone_number": "312-695-8182",
"fax_number": "312-695-7851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUTRA",
"first_name": "JOSE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-23",
"last_updated": "2009-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "IL",
"license": "036102537",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.