Provider Demographics
NPI:1467460337
Name:BUDZ, JEROME THOMAS (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:THOMAS
Last Name:BUDZ
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 1:2200 W HIGGINS RD
Mailing Address - Street 2:STE 215
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169
Mailing Address - Country:US
Mailing Address - Phone:847-882-8280
Mailing Address - Fax:847-882-8251
Practice Address - Street 1:901 N 1ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115
Practice Address - Country:US
Practice Address - Phone:815-756-8583
Practice Address - Fax:815-756-8813
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
645670Medicare ID - Type Unspecified
D14272Medicare UPIN