Provider Demographics
NPI:1215960026
Name:DUDLEY, LEE ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANTHONY
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 S HARPER AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4119
Mailing Address - Country:US
Mailing Address - Phone:773-983-1635
Mailing Address - Fax:
Practice Address - Street 1:5113 S HARPER AVE STE 2C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615
Practice Address - Country:US
Practice Address - Phone:773-983-1635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336.091115207P00000X
TXQ5791207P00000X
OH34008088207P00000X
NC2012-02286207P00000X
ALDO.1490207P00000X
DCDO034849207P00000X
MO2010025333207P00000X
GA057958207P00000X
MDH0064685207P00000X
HIDOS-1111207P00000X
TNDO0000001892207P00000X
IL036.129640207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H98131Medicare UPIN