Provider Demographics
NPI:1376503557
Name:KUDELKA, ANNE M (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:M
Last Name:KUDELKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:233 E ERIE ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2926
Mailing Address - Country:US
Mailing Address - Phone:312-846-6641
Mailing Address - Fax:312-374-1123
Practice Address - Street 1:233 E ERIE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2926
Practice Address - Country:US
Practice Address - Phone:312-846-6641
Practice Address - Fax:312-374-1123
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036087780174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087780Medicaid
ILG54306Medicare UPIN
IL284280Medicare ID - Type Unspecified