Provider Demographics
NPI:1902906092
Name:KUDMANI, GEORGE M (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:KUDMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9822 3RD STREET RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2847
Mailing Address - Country:US
Mailing Address - Phone:502-933-0623
Mailing Address - Fax:502-933-8388
Practice Address - Street 1:9822 3RD STREET RD
Practice Address - Street 2:SUITE 306
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2847
Practice Address - Country:US
Practice Address - Phone:502-933-0623
Practice Address - Fax:502-933-8388
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYKY21041207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64210412Medicaid
KY1352501Medicare PIN
KYC64262Medicare UPIN