NPIMap

Organization Active NPI

Pawel S. Dudek, M.D., S.C.

  • Psychiatry Physician
  • Chicago, IL
National Provider Identifier
1306056734
Registry record updated Jun 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036096327 Issued in IL
Legal business name
PAWEL S. DUDEK, M.D., S.C.
Practice address
4250 N Marine Dr
Suite 236
Chicago, IL 60613-1744
Phone
(773) 404-0160
Fax
(773) 404-9876
NPI assigned
May 23, 2007
Last updated
Jun 24, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Pawel Stanislaw Dudek, M.D.NPI 1043271554
Title
Board Certified Psychiatrist
Phone
(773) 909-6269

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 036096327 IL Primary

Addresses

Primary practice location

4250 N Marine Dr
Suite 236
Chicago, IL 60613-1744

Mailing address

4840 N Marine Dr
Chicago, IL 60640-7860
Phone (773) 654-1645

Other identifiers 7

IdentifierTypeStateIssuer
01635497OtherILBLUE CROSS BLUE SHIELD
415428OtherILMHN
036096327MedicaidIL
401806OtherILHARMONY
404206OtherILVALUE OPTIONS
2017926OtherILCIGNA
180759OtherILCOMPSYCH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277337600000",
    "number": "1306056734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4840 N MARINE DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606407860",
            "telephone_number": "773-654-1645",
            "fax_number": "773-681-0289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 N MARINE DR",
            "address_2": "SUITE 236",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606131744",
            "telephone_number": "773-404-0160",
            "fax_number": "773-404-9876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAWEL S. DUDEK, M.D., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2010-06-24",
        "status": "A",
        "authorized_official_last_name": "DUDEK",
        "authorized_official_first_name": "PAWEL",
        "authorized_official_middle_name": "STANISLAW",
        "authorized_official_title_or_position": "BOARD CERTIFIED PSYCHIATRIST",
        "authorized_official_telephone_number": "773-909-6269",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036096327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "01635497",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "415428",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036096327",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARMONY",
            "identifier": "401806",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "404206",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2017926",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPSYCH",
            "identifier": "180759",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.