Healthcare Provider Details

I. General information

NPI: 1902906092
Provider Name (Legal Business Name): GEORGE M KUDMANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9822 3RD STREET RD SUITE 306
LOUISVILLE KY
40272-2847
US

IV. Provider business mailing address

9822 3RD STREET RD SUITE 306
LOUISVILLE KY
40272-2847
US

V. Phone/Fax

Practice location:
  • Phone: 502-933-0623
  • Fax: 502-933-8388
Mailing address:
  • Phone: 502-933-0623
  • Fax: 502-933-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberKY21041
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: