Healthcare Provider Details

I. General information

NPI: 1346487972
Provider Name (Legal Business Name): ALEJANDRO D. KUDISCH M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E SAVANNAH AVE BLDG B -201
MCALLEN TX
78503-1241
US

IV. Provider business mailing address

110 EAST SAVANNAH BLDG B -201
MCALLEN TEXAS
78503-1291
UM

V. Phone/Fax

Practice location:
  • Phone: 956-687-3000
  • Fax: 956-687-7948
Mailing address:
  • Phone: 956-687-3000
  • Fax: 956-687-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberJ7546
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberJ7546
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberJ7546
License Number StateTX

VIII. Authorized Official

Name: DR. ALEJANDRO D KUDISCH
Title or Position: PSYCHISCIAN
Credential: M.D., DFAPA
Phone: 956-687-3000