MEDICARE: ALEX V BUDER 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		IL

General Provider Information

NPI Number	:	1700955358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX V BUDER M.D.,

Provider Business Mailing Address
First Line	:	2719 N HALSTED ST
Second Line	:	SUITE C-1
City	:	CHICAGO
State	:	IL
Zip	:	60614-1413
Country	:	US
Telephone Number	:	773-388-5685
Fax Number	:	773-388-5687

Provider Business Practice Location Address
First Line	:	2719 N HALSTED ST
Second Line	:	SUITE C-1
City	:	CHICAGO
State	:	IL
Zip	:	60614-1413
Country	:	US
Telephone Number	:	773-388-5685
Fax Number	:	773-388-5687

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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