Provider Demographics
NPI:1164418315
Name:NUDERA, ROBERT J (MD)
Entity Type:Individual
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First Name:ROBERT
Middle Name:J
Last Name:NUDERA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1256 WATERFORD DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:630-499-2404
Mailing Address - Fax:630-499-2399
Practice Address - Street 1:2040 OGDEN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7222
Practice Address - Country:US
Practice Address - Phone:630-978-6895
Practice Address - Fax:630-375-2905
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2019-02-07
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Provider Licenses
StateLicense IDTaxonomies
IL036-043320207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C39019Medicare UPIN