Basic Information
| Provider Information | |||||||||
| NPI: | 1003012022 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUDZILO | ||||||||
| FirstName: | COREY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 94670 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731434670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056823303 | ||||||||
| FaxNumber: | 4053846793 | ||||||||
| Practice Location | |||||||||
| Address1: | 2240 SUTHERLAND AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379192333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655888831 | ||||||||
| FaxNumber: | 8655888841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 50968 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 50968 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.