Provider Demographics
NPI:1689600835
Name:DUDAR, IRINA O (MD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:O
Last Name:DUDAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2800 N LAKE SHORE DR APT 3609
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6254
Mailing Address - Country:US
Mailing Address - Phone:773-975-1971
Mailing Address - Fax:773-975-1971
Practice Address - Street 1:4656 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1656
Practice Address - Country:US
Practice Address - Phone:847-972-2202
Practice Address - Fax:847-512-4353
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107984207LP2900X
IL036107984207L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636513OtherBCBS
IL036107984Medicaid
ILI19546Medicare UPIN
IL213850Medicare PIN