Thomas Anthony Koludrovic, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1916559 Issued in IL

Practice address

9760 S Kedzie Ave
Suite 4
Evergreen Park, IL 60805

Phone

(708) 499-0379

Fax

(708) 423-9021

NPI assigned

Jul 6, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1183680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740488154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9760 S KEDZIE AVE",
            "address_2": "SUITE 4",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "60805",
            "telephone_number": "708-499-0379",
            "fax_number": "708-423-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9760 S KEDZIE AVE",
            "address_2": "SUITE 4",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "60805",
            "telephone_number": "708-499-0379",
            "fax_number": "708-423-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLUDROVIC",
        "first_name": "THOMAS",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "1916559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Elizabeth Knight, PA-C
• Anne Knightly
• Alyssa Nicole Knueven, PA-C
• Kathleen Ann Kociak, RN, MS, GNP-BC
• Mark Anthony Koludrovic, DDS
• Emily R Konczal, O.D.
• Goutham Kondapi
• Elizabeth R Konieczny
• Anne Koronkiewicz, DO
• Bahij Kreidieh

• General Practice Dentistry in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.