Healthcare Provider Details

I. General information

NPI: 1053515429
Provider Name (Legal Business Name): DUANGNAPA S. CUDDY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S LANDMARK AVE
BLOOMINGTON IN
47403
US

IV. Provider business mailing address

550 S LANDMARK AVE
BLOOMINGTON IN
47403-3239
US

V. Phone/Fax

Practice location:
  • Phone: 812-355-6900
  • Fax:
Mailing address:
  • Phone: 812-355-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34C.000502
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number60418
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number02005581A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberOS22591
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number34C.000502
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number60418
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: