Healthcare Provider Details

I. General information

NPI: 1346282464
Provider Name (Legal Business Name): UK FAMILY PRACTICE, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E STRONG ST SUITE 3
WHEELING IL
60090-2979
US

IV. Provider business mailing address

201 E STRONG ST
WHEELING IL
60090-2979
US

V. Phone/Fax

Practice location:
  • Phone: 847-459-6308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DR. MIRA KUDER
Title or Position: CEO
Credential: MD, PHD
Phone: 847-459-6308