Provider Demographics
NPI:1982607511
Name:KUDER, MIROSLAWA A (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MIROSLAWA
Middle Name:A
Last Name:KUDER
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E STRONG ST
Mailing Address - Street 2:STE 3
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2979
Mailing Address - Country:US
Mailing Address - Phone:847-459-6308
Mailing Address - Fax:
Practice Address - Street 1:201 E STRONG ST
Practice Address - Street 2:STE 3
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2979
Practice Address - Country:US
Practice Address - Phone:847-459-6308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109233Medicaid