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Individual
BRIAN J CHUDIK
Active
Individual
BRIAN J CHUDIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036105407
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105407
—
IL
01
—
05632114
BLUE CROSS BLUE SHIELD
IL
01
—
05632414
BCBS PROV #
IL
01
—
610034000
IL DEPT OF LABOR
IL
Enumeration date
07/11/2005
Last updated
09/27/2022
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