MEDICARE: ROBERT J NUDERA M.D.

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	207Y00000X	Otolaryngology Physician	036-043320	IL

General Provider Information

NPI Number	:	1164418315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J NUDERA M.D.

Provider Business Mailing Address
First Line	:	1256 WATERFORD DRIVE
Second Line	:	SUITE 230
City	:	AURORA
State	:	IL
Zip	:	60504
Country	:	US
Telephone Number	:	630-499-2404
Fax Number	:	630-499-2399

Provider Business Practice Location Address
First Line	:	2040 OGDEN AVE
Second Line	:	SUITE 301
City	:	AURORA
State	:	IL
Zip	:	60504-7222
Country	:	US
Telephone Number	:	630-978-6895
Fax Number	:	630-375-2905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	02/07/2019

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