Provider Demographics
NPI:1376541763
Name:CHUDIK, BRIAN J (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:CHUDIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:600 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5996
Practice Address - Country:US
Practice Address - Phone:224-783-4365
Practice Address - Fax:224-783-4356
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05632114OtherBLUE CROSS BLUE SHIELD
IL036105407Medicaid
IL05632414OtherBCBS PROV #
IL610034000OtherIL DEPT OF LABOR
IL210175Medicare PIN
IL210176Medicare UPIN
ILIL2304003Medicare PIN
IL610034000OtherIL DEPT OF LABOR
ILH72152Medicare UPIN
ILP00177454Medicare PIN
IL05632114OtherBLUE CROSS BLUE SHIELD