Basic Information
Provider Information
NPI: 1003012022
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CUDZILO
FirstName: COREY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0200X50968TNN Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
207RP1001X50968TNY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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