Individual
MARY DUDEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2645 W. LAWRENCE AVE., CHICAGO, IL 60625
(773) 275-1680
(773) 275-1681
Mailing address
2645 W. LAWRENCE AVE., CHICAGO, IL 60625
(773) 275-1680
(773) 275-1681
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-000753
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-000753
STATE LICENSE
IL
Enumeration date
12/05/2006
Last updated
11/23/2011
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