Provider Demographics
NPI:1154497253
Name:EDWARD N TUDER MD SC
Entity Type:Organization
Organization Name:EDWARD N TUDER MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:TUDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-943-0378
Mailing Address - Street 1:150 E HURON ST
Mailing Address - Street 2:STE 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 ST
Practice Address - Street 2:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C41817Medicare UPIN
IL471110Medicare ID - Type Unspecified