Provider Demographics
NPI:1073662730
Name:HUDSON, VALERIE K (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:K
Last Name:HUDSON
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 1:796 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1803
Mailing Address - Country:US
Mailing Address - Phone:313-824-9682
Mailing Address - Fax:
Practice Address - Street 1:20440 HARPER AVE
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1644
Practice Address - Country:US
Practice Address - Phone:313-640-9400
Practice Address - Fax:313-640-8878
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060360207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI001452OtherMIDWEST
MI142485OtherPREFERRED CHOICES
MI13182OtherGREAT LAKES
MI1108247812OtherBLUE CROSS
MI142485OtherCARE CHOICES
MI130767800OtherU.S. DEPT OF LABOR
MI104270096Medicaid
MIG34915OtherHAP
MI761-2OtherTOTAL HEALTH CARE
MI761-2OtherTOTAL HEALTH CARE
MI104270096Medicaid