Provider Demographics
NPI:1093989170
Name:TUDER, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:TUDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E HURON STREET
Mailing Address - Street 2:SUITE 1306
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2962
Mailing Address - Country:US
Mailing Address - Phone:312-943-0378
Mailing Address - Fax:312-943-9943
Practice Address - Street 1:150 E HURON STREET
Practice Address - Street 2:SUITE 1306
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2962
Practice Address - Country:US
Practice Address - Phone:312-943-0378
Practice Address - Fax:312-943-9943
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL471110Medicare PIN
ILC41817Medicare UPIN