Provider Demographics
NPI:1770665713
Name:ONDREJ CHUDOBA, M.D.
Entity Type:Organization
Organization Name:ONDREJ CHUDOBA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ONDREJ
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUDOBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-415-3087
Mailing Address - Street 1:11924 OAK CREEK PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142
Mailing Address - Country:US
Mailing Address - Phone:847-515-8131
Mailing Address - Fax:847-515-8142
Practice Address - Street 1:11924 OAK CREEK PARKWAY
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142
Practice Address - Country:US
Practice Address - Phone:847-515-8131
Practice Address - Fax:847-515-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627496OtherBLUE SHIELD BLUE CROSS
IL211396Medicare ID - Type Unspecified
ILF19510Medicare UPIN