Healthcare Provider Details

I. General information

NPI: 1376503557
Provider Name (Legal Business Name): ANNE M KUDELKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E ERIE ST SUITE 305
CHICAGO IL
60611-2926
US

IV. Provider business mailing address

233 E ERIE ST SUITE 305
CHICAGO IL
60611-2926
US

V. Phone/Fax

Practice location:
  • Phone: 312-846-6641
  • Fax: 312-374-1123
Mailing address:
  • Phone: 312-846-6641
  • Fax: 312-374-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036087780
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036087780
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: