MEDICARE: EDWARD N TUDER MD SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1154497253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD N TUDER MD SC

Provider Business Mailing Address
First Line	:	150 E HURON ST
Second Line	:	STE 1306
City	:	CHICAGO
State	:	IL
Zip	:	60611-2962
Country	:	US
Telephone Number	:	312-943-0378
Fax Number	:	312-943-9943

Provider Business Practice Location Address
First Line	:	150 E HURON ST
Second Line	:	STE 1306
City	:	CHICAGO
State	:	IL
Zip	:	60611-2962
Country	:	US
Telephone Number	:	312-943-0378
Fax Number	:	312-943-9943

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD NEAL TUDER
Credential	:	MD
Telephone Number	:	312-943-0378

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	02/21/2014

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