Individual
DR. PHILIP S DUDAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC, FNP-C
Contact information
Practice address
11133 DUNN RD, SAINT LOUIS, MO 63136-6163
(314) 653-5228
Mailing address
11125 DUNN RD STE 100, SAINT LOUIS, MO 63136-6132
(314) 653-5228
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
005778
MO
111N00000X
Chiropractor
038006559
IL
363L00000X
Nurse Practitioner
2013003629
MO
363L00000X
Nurse Practitioner
209010226
IL
363LF0000X
Family Nurse Practitioner
2013003629
MO
363LF0000X
Family Nurse Practitioner
Primary
209010226
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118828
BCBS
IL
01
—
4400267
UHC
—
Enumeration date
01/13/2006
Last updated
07/29/2021
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