Provider Demographics
NPI:1215027743
Name:DUDA, ZENON M (DPM)
Entity Type:Individual
Prefix:DR
First Name:ZENON
Middle Name:M
Last Name:DUDA
Suffix:
Gender:M
Credentials:DPM
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Other - First Name:
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Mailing Address - Street 1:145 S MOUNT AUBURN RD
Mailing Address - Street 2:STE B
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4913
Mailing Address - Country:US
Mailing Address - Phone:573-334-1080
Mailing Address - Fax:573-334-2748
Practice Address - Street 1:145 S MOUNT AUBURN RD
Practice Address - Street 2:STE B
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4913
Practice Address - Country:US
Practice Address - Phone:573-334-1080
Practice Address - Fax:573-334-2748
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO000473213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO31553202Medicaid
MO213270001Medicare PIN
MOT42879Medicare UPIN