Healthcare Provider Details

I. General information

NPI: 1750330163
Provider Name (Legal Business Name): DAVID BRIAN GUDKESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 E GREENVILLE AVE
WINCHESTER IN
47394-9436
US

IV. Provider business mailing address

9588 VALPARAISO CT
INDIANAPOLIS IN
46268-1130
US

V. Phone/Fax

Practice location:
  • Phone: 765-584-0249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01038360A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: