Provider Demographics
NPI:1003079138
Name:NEDELKA, MICHELE A (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:NEDELKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WATER ST
Mailing Address - Street 2:SUITE J-100
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-3523
Mailing Address - Country:US
Mailing Address - Phone:830-257-3131
Mailing Address - Fax:830-257-3161
Practice Address - Street 1:1001 WATER ST
Practice Address - Street 2:SUITE J-100
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3523
Practice Address - Country:US
Practice Address - Phone:830-257-3131
Practice Address - Fax:830-257-3161
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116020811390200000X
TXP75212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program