Provider Demographics
NPI:1134299498
Name:SAVAGE, JUDITH GRACE (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:GRACE
Last Name:SAVAGE
Suffix:
Gender:F
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:PO BOX 1261
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-8061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16750 80TH AVE STE D
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3174
Practice Address - Country:US
Practice Address - Phone:708-633-9000
Practice Address - Fax:708-633-9016
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36057564208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36057564Medicaid
F26240Medicare UPIN