Individual
DR. FRED J KUDRIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
166 STONERIDGE DR, COLUMBIA, SC 29210-8239
(803) 461-3000
(803) 461-4910
Mailing address
PO BOX 2046, WEST COLUMBIA, SC 29171-2046
(803) 461-3000
(803) 461-4910
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
22933
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
229336
—
SC
01
—
6275
MCARE GROUP#
SC
Enumeration date
11/10/2005
Last updated
11/12/2009
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