Provider Demographics
NPI:1649289893
Name:KERN, JUDY (MD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:KERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N MICHIGAN AVENUE #508
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7506
Mailing Address - Country:US
Mailing Address - Phone:773-752-2504
Mailing Address - Fax:888-981-7118
Practice Address - Street 1:155 N MICHIGAN AVE STE 508
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7708
Practice Address - Country:US
Practice Address - Phone:773-752-2504
Practice Address - Fax:888-981-7118
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360614592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31600380OtherBLUE CROSS BLUE SHIELD