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1043271554 NPI number — PAWEL S DUDEK M.D.

NPI Number: 1043271554
Health Care Provider/Practitioner: PAWEL S DUDEK M.D.

Information about “1043271554” NPI (PAWEL S DUDEK M.D.) exists in 1043271554 in HTML format HTML  |  1043271554 in plain Text format TXT  |  1043271554 in PDF (Portable Document Format) PDF  |  1043271554 in an XML format XML  formats.

NPI Number : 1043271554 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043271554",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DUDEK",
    "FirstName": "PAWEL",
    "MiddleName": "S",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DUDEK",
    "OtherFirstName": "PAWEL",
    "OtherMiddleName": "S",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.D., S.C.",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "4840 N MARINE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60640-7860",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "773-654-1645",
    "MailingAddressFaxNumber": "773-681-9876",
    "FirstLinePracticeLocationAddress": "4250 N MARINE DR",
    "SecondLinePracticeLocationAddress": "SUITE 236",
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60613-1744",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "773-404-0160",
    "PracticeLocationAddressFaxNumber": "773-404-9876",
    "EnumerationDate": "04/01/2006",
    "LastUpdateDate": "06/24/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2084P0800X",
        "TaxonomyName": "Psychiatry Physician",
        "LicenseNumber": "036096327",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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