Provider Demographics
NPI:1053397851
Name:CUDECKI, JOHN J (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:CUDECKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2850 S WABASH AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2955
Mailing Address - Country:US
Mailing Address - Phone:312-842-4400
Mailing Address - Fax:312-842-4595
Practice Address - Street 1:2850 S WABASH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2955
Practice Address - Country:US
Practice Address - Phone:312-842-4400
Practice Address - Fax:312-842-4595
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2019-07-12
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Provider Licenses
StateLicense IDTaxonomies
IL036080214208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036080214Medicaid
IL01621679OtherBCBS OF IL
IL036080214Medicaid
ILF 56812Medicare UPIN