Individual
ANTHONY L KUDIRKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 HARRINGTON ST, MOUNT CLEMENS, MI 48043-2920
(586) 493-8098
(586) 493-8706
Mailing address
PO BOX 1108, ATTN: BARB SIMMONS, ANN ARBOR, MI 48106-1108
(734) 677-7400
(734) 677-7407
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301050082
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300119457
MEDICARE RR PIN
MI
01
—
3005011962
BCBS INDIVIDUAL #
MI
01
—
310E011330
BCBS GROUP#
MI
05
—
4085418
—
MI
Enumeration date
06/29/2006
Last updated
11/26/2007
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