Provider Demographics
NPI:1043271554
Name:DUDEK, PAWEL S (MD)
Entity Type:Individual
Prefix:
First Name:PAWEL
Middle Name:S
Last Name:DUDEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAWEL
Other - Middle Name:S
Other - Last Name:DUDEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, SC
Mailing Address - Street 1:4840 N MARINE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7860
Mailing Address - Country:US
Mailing Address - Phone:773-654-1645
Mailing Address - Fax:773-681-9876
Practice Address - Street 1:4250 N MARINE DR
Practice Address - Street 2:SUITE 236
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1744
Practice Address - Country:US
Practice Address - Phone:773-404-0160
Practice Address - Fax:773-404-9876
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360963272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096327Medicaid
IL401806OtherHARMONY
IL01635497OtherBLUE CROSS BLUE SHIELD IL
IL404206OtherVALUE OPTIONS
IL2017926OtherCIGNA
IL415428OtherMHN
IL180759OtherCOMPSYCH
IL202916979OtherTIN
IL202916979OtherTIN
ILG59398Medicare UPIN