Healthcare Provider Details

I. General information

NPI: 1306912654
Provider Name (Legal Business Name): MICHAEL KARL KUDUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/21/2022
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST # H405
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

800 ROSE ST # H404
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-2919
  • Fax: 859-257-1632
Mailing address:
  • Phone: 859-218-2919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34354
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34354
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: