Provider Demographics
NPI:1174109854
Name:MUDD, MARTA KAROLINA (MD, PHD)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:KAROLINA
Last Name:MUDD
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N FRANKLIN ST STE 401
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-7212
Mailing Address - Country:US
Mailing Address - Phone:800-442-8938
Mailing Address - Fax:
Practice Address - Street 1:720 N FRANKLIN ST STE 401
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-7212
Practice Address - Country:US
Practice Address - Phone:800-442-8938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250786542084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry