Provider Demographics
NPI:1750603395
Name:POMPILIA C TUDORIU M.D. S.C.
Entity type:Organization
Organization Name:POMPILIA C TUDORIU M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:POMPILIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:TUDORIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-926-7100
Mailing Address - Street 1:PO BOX 7000
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-7000
Mailing Address - Country:US
Mailing Address - Phone:312-926-7100
Mailing Address - Fax:312-926-7400
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 2220
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-926-7100
Practice Address - Fax:312-926-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH13952Medicare UPIN