Individual
JENNIFER ANN DUDAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
908 N ELM ST, SUITE 300, HINSDALE, IL 60521-3625
(630) 455-1756
(630) 455-1759
Mailing address
18425 W CREEK DR STE F, TINLEY PARK, IL 60477-6768
(708) 444-8300
(708) 444-8301
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085001954
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050540914
GROUP TAX ID #
IL
01
—
085001954
LICENSE
IL
01
—
1056683
CERTIFICATE NUMBER
IL
01
—
P00382533/CK6882
RAILROAD MEDICARE PIN
IL
Enumeration date
09/24/2006
Last updated
12/21/2021
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