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General NPI Number Information
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NPI Number | 1306056734
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Entity Type | Organization
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Legal Business Name | PAWEL S. DUDEK, M.D., S.C.
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 4250 N MARINE DR SUITE 236
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City | CHICAGO
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State | IL
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Zip | 60613-1744
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Country | US
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Telephone | 773-404-0160
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Fax | 773-404-9876
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Provider Business Mailing Address
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Address Line | 4840 N MARINE DR
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City | CHICAGO
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State | IL
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Zip | 60640-7860
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Country | US
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Telephone | 773-654-1645
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Fax | 773-681-0289
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Authorized Official
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Title or Position | BOARD CERTIFIED PSYCHIATRIST
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Name | MR. PAWEL STANISLAW DUDEK
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Credential | M.D.
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Telephone | 773-909-6269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036096327
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License Number State | IL
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