MEDICARE: MARC L KUDISCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	J1289	TX
2	207RG0100X	Gastroenterology Physician	DR.0065485	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093716375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC L KUDISCH MD

Provider Business Mailing Address
First Line	:	3030 S GESSNER RD STE 120
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-3770
Country	:	US
Telephone Number	:	713-777-9995
Fax Number	:	713-777-0100

Provider Business Practice Location Address
First Line	:	3030 S GESSNER RD STE 120
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-3770
Country	:	US
Telephone Number	:	713-777-9995
Fax Number	:	713-777-0100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	01/20/2021

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