Provider Demographics
NPI:1912920265
Name:WEDDABURNE, CLAUDIA M (MD)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:M
Last Name:WEDDABURNE
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 1:4343 N CLARENDON AVE
Mailing Address - Street 2:APT 1902
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2698
Mailing Address - Country:US
Mailing Address - Phone:773-871-2457
Mailing Address - Fax:
Practice Address - Street 1:RESURRECTION IMMEDIATE CARE CENTER
Practice Address - Street 2:7230 W. NORTH AVE STE 106 B
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4262
Practice Address - Country:US
Practice Address - Phone:708-453-3000
Practice Address - Fax:708-453-4660
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036069378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069378Medicaid
IL1620469OtherBCBS GROUP NUMBER
IL1619414OtherBCBS GROUP
IL036069378Medicaid
IL1620469OtherBCBS GROUP NUMBER
ILD89913Medicare UPIN
ILK08445Medicare ID - Type Unspecified