Individual
BRIAN J CHUDIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
600 S RANDALL RD, ALGONQUIN, IL 60102-5996
(224) 783-4365
(224) 783-4356
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
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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