Provider Demographics
NPI:1932158359
Name:DZUDZA, ELDIN (MD)
Entity Type:Individual
Prefix:
First Name:ELDIN
Middle Name:
Last Name:DZUDZA
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 1:4770 N. LINCOLN AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1056
Mailing Address - Country:US
Mailing Address - Phone:708-756-0100
Mailing Address - Fax:708-709-6353
Practice Address - Street 1:4770 N. LINCOLN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1056
Practice Address - Country:US
Practice Address - Phone:708-756-0100
Practice Address - Fax:708-709-6353
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361005142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100514Medicaid
IL036100514Medicaid