Healthcare Provider Details

I. General information

NPI: 1043390610
Provider Name (Legal Business Name): FRED WILLIAM CUDNOHUFSKY CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W SAGINAW ST 2ND FLOOR
LANSING MI
48915-1927
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-7601
  • Fax: 517-364-7648
Mailing address:
  • Phone: 517-364-6253
  • Fax: 517-364-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801063045
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: