Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036080214 | IL |
NPI | 1053397851 |
---|---|
Provider Name | John J Cudecki |
First Address | Chicago, IL 60616-2955 |
Second Address | Chicago, IL 60616-2955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 12/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01621679 | BCBS OF IL (01) | IL |
036080214 | (05) | IL |
F 56812 | (02) | IL |