Provider Demographics
NPI:1285724906
Name:CHUDOBA, ONDREJ (MD)
Entity type:Individual
Prefix:
First Name:ONDREJ
Middle Name:
Last Name:CHUDOBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11317 SMITH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9602
Mailing Address - Country:US
Mailing Address - Phone:630-415-3087
Mailing Address - Fax:708-488-1050
Practice Address - Street 1:11317 SMITH DR
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9602
Practice Address - Country:US
Practice Address - Phone:630-415-3087
Practice Address - Fax:708-488-1050
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360814922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081492Medicaid
IL162496OtherBLUE CROSS/BLUE SHIELD
IL211396Medicare ID - Type Unspecified
IL036081492Medicaid