Provider Demographics
NPI:1720148810
Name:HUDOBA, PAVEL (MD)
Entity Type:Individual
Prefix:
First Name:PAVEL
Middle Name:
Last Name:HUDOBA
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 1:303 E ARMY TRAIL RD
Mailing Address - Street 2:SUITE 407
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2169
Mailing Address - Country:US
Mailing Address - Phone:630-980-4922
Mailing Address - Fax:630-980-4923
Practice Address - Street 1:303 E ARMY TRAIL RD
Practice Address - Street 2:SUITE 407
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2169
Practice Address - Country:US
Practice Address - Phone:630-980-4922
Practice Address - Fax:630-980-4923
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7566105OtherAETNA PROVIDER NUMBER
IL02232241OtherBCBS PROVIDER NUMBER
IL8251421OtherCIGNA PROVIDER NUMBER
ILP00188276OtherRAILROAD MEDICARE NUMBER
IL02232241OtherBCBS PROVIDER NUMBER
ILP00188276OtherRAILROAD MEDICARE NUMBER