Healthcare Provider Details

I. General information

NPI: 1932158359
Provider Name (Legal Business Name): ELDIN DZUDZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 N. LINCOLN AVE SUITE 7
CHICAGO IL
60625-1056
US

IV. Provider business mailing address

4770 N. LINCOLN AVE SUITE 7
CHICAGO IL
60625-1056
US

V. Phone/Fax

Practice location:
  • Phone: 708-756-0100
  • Fax: 708-709-6353
Mailing address:
  • Phone: 708-756-0100
  • Fax: 708-709-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036100514
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: