MEDICARE: DR. CHARLES J GUDAS DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	104	SC

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	:	1972507812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES J GUDAS DPM

Provider Business Mailing Address
First Line	:	2097 HENRY TECKLENBURG DR
Second Line	:	STE 210W
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5739
Country	:	US
Telephone Number	:	843-852-9444
Fax Number	:	843-852-9404

Provider Business Practice Location Address
First Line	:	2097 HENRY TECKLENBURG DR
Second Line	:	STE 210W
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5739
Country	:	US
Telephone Number	:	843-852-9444
Fax Number	:	843-852-9404

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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