Basic Information
| Provider Information | |||||||||
| NPI: | 1144211160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUDRAY | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1314 S LINDEN RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421700 | ||||||||
| FaxNumber: | 8107204057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101008921 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0192508465 | 01 | MI | HEALTH PLUS | OTHER | C1640 | 01 | MA | MCARE | OTHER | 204381 | 01 | MI | HEALTH ADVANTAGE NETWORK | OTHER | 0152508465 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 080098250/CD3610 | 01 | MI | METRAHEALTH | OTHER | E26245 | 01 | MI | HEALTH ALLIANCE PLAN | OTHER | 204381 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 4073608 | 01 | MI | AETNA | OTHER | 4380463 | 05 | MI | MEDICAID | 1982939 | 01 | MI | CIGNA | OTHER | E26245 | 01 | MI | HEALTH NET FEDERAL SERV | OTHER |