MEDICARE: MARTA KAROLINA MUDD MD, PHD

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	2084P0800X	Psychiatry Physician	125078654	IL

General Provider Information

NPI Number	:	1174109854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTA KAROLINA MUDD MD, PHD

Provider Business Mailing Address
First Line	:	720 N FRANKLIN ST STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-7212
Country	:	US
Telephone Number	:	800-442-8938
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 N FRANKLIN ST STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-7212
Country	:	US
Telephone Number	:	800-442-8938
Fax Number	:

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

Provider Enumeration Date	:	03/22/2021
Last Update Date	:	07/21/2025

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