Individual
DR. NENITA C TUDTUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1015 S MERCER AVE, BLOOMINGTON, IL 61701-7107
(309) 662-7500
(309) 662-7333
Mailing address
1015 S MERCER AVE, BLOOMINGTON, IL 61701-7107
(309) 662-7500
(309) 662-7333
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036-052568
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036052568
—
IL
01
—
833120
MEDICARE GROUP #
IL
01
—
CA2264
RR MEDICARE GROUP #
IL
01
—
P00706576
RR INDIVIDUAL #
—
Enumeration date
06/25/2006
Last updated
10/22/2009
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