Individual
ANDRZEJ M DUDAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1221 E STATE ST, ROCKFORD, IL 61104-2231
(815) 972-1000
(815) 972-1086
Mailing address
1221 E STATE ST, ROCKFORD, IL 61104-2231
(815) 972-1000
(815) 972-1086
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-126851
IL
207Q00000X
Family Medicine Physician
125-054982
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036126851
PHYSICIAN LICENSE
IL
Enumeration date
06/24/2008
Last updated
08/09/2011
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