Provider Demographics
NPI:1346294642
Name:JOSEPH, JUDY (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2201 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-7770
Mailing Address - Country:US
Mailing Address - Phone:847-998-8110
Mailing Address - Fax:773-764-9781
Practice Address - Street 1:3048 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3720
Practice Address - Country:US
Practice Address - Phone:773-764-9780
Practice Address - Fax:773-764-9781
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG79739Medicare UPIN
IL488210Medicare ID - Type Unspecified