MEDICARE: JOSEPH Z. PUDLO, M.D. S.C.

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	036-072100	IL

General Provider Information

NPI Number	:	1316206733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH Z. PUDLO, M.D. S.C.

Provider Business Mailing Address
First Line	:	6145 N. MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-3804
Country	:	US
Telephone Number	:	773-631-2442
Fax Number	:	773-631-6530

Provider Business Practice Location Address
First Line	:	6145 N. MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-3804
Country	:	US
Telephone Number	:	773-631-2442
Fax Number	:	773-631-6530

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	JOSEPH ZBIGNIEW PUDLO
Credential	:	M.D.
Telephone Number	:	773-631-2442

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	05/15/2012

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