Healthcare Provider Details

I. General information

NPI: 1396790739
Provider Name (Legal Business Name): ANDRIUS KUDIRKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVENUE SUITE 221 S.
ORLAND PARK IL
60462
US

IV. Provider business mailing address

12251 S 80TH AVE SUITE 1630
PALOS HEIGHTS IL
60463-1256
US

V. Phone/Fax

Practice location:
  • Phone: 708-590-5300
  • Fax: 708-590-5310
Mailing address:
  • Phone: 708-590-5300
  • Fax: 708-590-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036110338
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: