Healthcare Provider Details

I. General information

NPI: 1366082588
Provider Name (Legal Business Name): PAIGE GUDIM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 04/16/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

820 S WOOD ST # MC808
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-7500
  • Fax: 312-413-3856
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209029258
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: