Provider Demographics
NPI:1699258616
Name:DUDIC, TERESA (SURGICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:DUDIC
Suffix:
Gender:F
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-0543
Mailing Address - Country:US
Mailing Address - Phone:708-452-6897
Mailing Address - Fax:708-695-9166
Practice Address - Street 1:2622 N 77TH CT
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-1801
Practice Address - Country:US
Practice Address - Phone:888-265-9908
Practice Address - Fax:888-265-5564
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000576246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant