Basic Information
| Provider Information | |||||||||
| NPI: | 1942388459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUDOR | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DUDOR | ||||||||
| OtherFirstName: | BRIAN | ||||||||
| OtherMiddleName: | JOSEPH | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 - 15TH AVENUE | ||||||||
| Address2: | STE 180 | ||||||||
| City: | SOUTH MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531721160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147685430 | ||||||||
| FaxNumber: | 4147624225 | ||||||||
| Practice Location | |||||||||
| Address1: | S74 W16775 JANESVILLE ROAD | ||||||||
| Address2: | |||||||||
| City: | MUSKEGO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531507742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144222180 | ||||||||
| FaxNumber: | 4144222185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 02/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 39036 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.