Provider Demographics
NPI:1235516774
Name:WLODARSKI, RICHARD TED (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:TED
Last Name:WLODARSKI
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 1:2180 PFINGSTEN RD STE 2000
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1339
Mailing Address - Country:US
Mailing Address - Phone:847-570-2570
Mailing Address - Fax:847-570-2073
Practice Address - Street 1:2180 PFINGSTEN RD STE 2000
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1339
Practice Address - Country:US
Practice Address - Phone:847-570-2570
Practice Address - Fax:847-570-2073
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361482382084N0400X, 2084N0400X
IL125-0667232084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program