Basic Information
| Provider Information | |||||||||
| NPI: | 1285920538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUDNIK | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FORD PL STE 3A | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482023450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138744806 | ||||||||
| FaxNumber: | 3138761305 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 W WASHINGTON AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492012160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172054800 | ||||||||
| FaxNumber: | 3138761305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2011 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 75997 | GA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 005081 | GA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | EMC0002519 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | MD.36916 | AL | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | EMC0002519 | MI | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.