Individual
JUDITH KUCZEK WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
18181 PEARL RD, B202, STRONGSVILLE, OH 44136-6949
(440) 816-4960
Mailing address
PO BOX 30610, CLEVELAND, OH 44130-0610
(440) 816-6429
(440) 816-6438
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-06-7582-W
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000077081
ANTHEM PIN
OH
01
—
0007634033
AETNA
OH
01
—
080163899
RAILROAD MEDICARE
OH
01
—
0843940002
DMERC
OH
05
—
2123544
—
OH
05
—
2238199
—
OH
01
—
341652755011
TRICARE
OH
01
—
3416527556P00
ANTHEM GROUP
OH
01
—
86542
QUAL CHOICE
OH
Enumeration date
12/22/2005
Last updated
12/28/2020
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