Healthcare Provider Details

I. General information

NPI: 1073582433
Provider Name (Legal Business Name): SUSAN JANE KUDLINSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E PECOS RD STE 235
GILBERT AZ
85295-3207
US

IV. Provider business mailing address

1760 E PECOS RD STE 235
GILBERT AZ
85295-3207
US

V. Phone/Fax

Practice location:
  • Phone: 480-813-0944
  • Fax: 480-813-0038
Mailing address:
  • Phone: 480-813-0944
  • Fax: 480-813-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25219
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: