Healthcare Provider Details

I. General information

NPI: 1831134188
Provider Name (Legal Business Name): JAMES KUDRNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1884 OLD WILLOW RD UNIT 1A
NORTHFIELD IL
60093-2956
US

IV. Provider business mailing address

1884 OLD WILLOW RD UNIT 1A
NORTHFIELD IL
60093-2956
US

V. Phone/Fax

Practice location:
  • Phone: 847-975-1562
  • Fax:
Mailing address:
  • Phone: 847-975-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number036055039
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036-055039
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: