Healthcare Provider Details

I. General information

NPI: 1649582727
Provider Name (Legal Business Name): HEATHER L KUDUK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER L GRAY MD

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N OAK AVE
MARSHFIELD WI
54449-5703
US

IV. Provider business mailing address

900 ILLINOIS AVE
STEVENS POINT WI
54481-3114
US

V. Phone/Fax

Practice location:
  • Phone: 715-387-5511
  • Fax:
Mailing address:
  • Phone: 715-346-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number68173-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number68173
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.135293
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: