MEDICARE: MRS. MARTA A DUDEK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	038099703	IL

General Provider Information

NPI Number	:	1083666432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTA A DUDEK M.D.

Provider Business Mailing Address
First Line	:	5528 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1227
Country	:	US
Telephone Number	:	773-631-2015
Fax Number	:	773-631-2040

Provider Business Practice Location Address
First Line	:	5528 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1227
Country	:	US
Telephone Number	:	773-631-2015
Fax Number	:	773-631-2040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	09/16/2011

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