Active NPI
Michael S Duda, DDS
- Dentist
- Kenilworth, IL
National Provider Identifier
1730400623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019028318
- Practice address
- 534 Green Bay Rd
Kenilworth, IL 60043-1801 - Phone
- (847) 251-5136
- NPI assigned
- Jun 15, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019028318 | IL | Primary |
Addresses
Primary practice location
534 Green Bay Rd
Kenilworth, IL 60043-1801
Mailing address
2035 W Dickens Ave
Chicago, IL 60647-4530
Phone (847) 571-0766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019028318 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432166400000",
"number": "1730400623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2035 W DICKENS AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606474530",
"telephone_number": "847-571-0766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "534 GREEN BAY RD",
"city": "KENILWORTH",
"state": "IL",
"postal_code": "600431801",
"telephone_number": "847-251-5136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUDA",
"first_name": "MICHAEL",
"middle_name": "S",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-06-15",
"last_updated": "2015-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019028318",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenilworth, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.