Healthcare Provider Details

I. General information

NPI: 1235198623
Provider Name (Legal Business Name): BRUCE TIMOTHY KUDRYK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W BAY ST #301 RADIOLOGY ASSOCIATES OF TAMPA INC
TAMPA FL
33606-2742
US

IV. Provider business mailing address

511 W BAY ST #301 RADIOLOGY ASSOCIATES OF TAMPA INC
TAMPA FL
33606-2742
US

V. Phone/Fax

Practice location:
  • Phone: 813-251-5822
  • Fax: 813-254-4597
Mailing address:
  • Phone: 813-251-5822
  • Fax: 813-254-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME63296
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME63296
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: