Provider Demographics
NPI:1699722496
Name:CUDAHY, JANET (MD,)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:CUDAHY
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 ARBOR VITAE RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2304
Mailing Address - Country:US
Mailing Address - Phone:847-441-8886
Mailing Address - Fax:
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:SUITE 209B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5188
Practice Address - Country:US
Practice Address - Phone:773-296-3500
Practice Address - Fax:773-296-3537
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID716060Medicare ID - Type Unspecified
ILD15277Medicare UPIN