Provider Demographics
NPI:1144211160
Name:KUDRAY, KATHLEEN L (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:L
Last Name:KUDRAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:1314 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3456
Practice Address - Country:US
Practice Address - Phone:810-342-1700
Practice Address - Fax:810-720-4057
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0192508465OtherHEALTH PLUS
MAC1640OtherMCARE
MI204381OtherHEALTH ADVANTAGE NETWORK
MA0152508465OtherBLUE CROSS BLUE SHIELD
MI080098250/CD3610OtherMETRAHEALTH
MIE26245OtherHEALTH ALLIANCE PLAN
MI204381OtherMCLAREN HEALTH PLAN
MI4073608OtherAETNA
MI4380463Medicaid
MI1982939OtherCIGNA
MIE26245OtherHEALTH NET FEDERAL SERV
MIE26245OtherHEALTH NET FEDERAL SERV
MA0152508465OtherBLUE CROSS BLUE SHIELD