Provider Demographics
NPI:1750509808
Name:CHUDNOW, IVAN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:PAUL
Last Name:CHUDNOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:I.
Other - Middle Name:PAUL
Other - Last Name:CHUDNOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:505 SW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1041
Mailing Address - Country:US
Mailing Address - Phone:954-760-9245
Mailing Address - Fax:
Practice Address - Street 1:505 SW 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-1041
Practice Address - Country:US
Practice Address - Phone:954-760-9245
Practice Address - Fax:954-760-9313
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 19425207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD 009390 EOtherSTATE LICENSE
FLME 19425OtherSTATE LICENSE
CAGFE22093OtherSTATE LICENSE
AC5131800OtherBNDD
FLD 51806Medicare UPIN
FLME 19425OtherSTATE LICENSE