Provider Demographics
NPI:1396790739
Name:KUDIRKA, ANDRIUS (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRIUS
Middle Name:
Last Name:KUDIRKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12251 S 80TH AVE
Mailing Address - Street 2:SUITE 1630
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1256
Mailing Address - Country:US
Mailing Address - Phone:708-590-5300
Mailing Address - Fax:708-590-5310
Practice Address - Street 1:15300 WEST AVENUE
Practice Address - Street 2:SUITE 221 S.
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462
Practice Address - Country:US
Practice Address - Phone:708-590-5300
Practice Address - Fax:708-590-5310
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110338Medicaid
ILIL332310OtherMEDICARE PTAN
ILK15039Medicare ID - Type UnspecifiedLOCALITY 15 - WILL COUNTY
IL206428Medicare ID - Type UnspecifiedGROUP WILL LOCALITY 15
ILR02081OtherMEDICARE IND PTAN
IL206427Medicare ID - Type UnspecifiedGROUP COOK LOCALITY 16
ILK15038Medicare ID - Type UnspecifiedLOCALITY 16 - COOK COUNTY
IL036110338Medicaid