Individual
CHARLES WILLIAM KUDER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3990 JOHN R ST, DETROIT, MI 48201-2018
(313) 745-8058
Mailing address
3607 HANNAN RD APT 114, WAYNE, MI 48184-2830
(734) 255-8894
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201009701
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689635526
—
MI
Enumeration date
06/12/2018
Last updated
06/12/2018
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