Provider Demographics
NPI:1508837956
Name:KUDALKAR, MEENA KISHOR (MD)
Entity Type:Individual
Prefix:DR
First Name:MEENA
Middle Name:KISHOR
Last Name:KUDALKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2201
Mailing Address - Country:US
Mailing Address - Phone:708-423-2258
Mailing Address - Fax:708-423-2305
Practice Address - Street 1:6311 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2201
Practice Address - Country:US
Practice Address - Phone:708-423-2258
Practice Address - Fax:708-423-2305
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061350207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL050051124OtherRR MEDICARE
ILC45681Medicare UPIN
ILL39508Medicare PIN