Provider Demographics
NPI:1225014111
Name:CUDAHY, TERENCE J (MD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:J
Last Name:CUDAHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:2560 N. SHADELAND AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1706
Practice Address - Country:US
Practice Address - Phone:317-275-8022
Practice Address - Fax:317-275-8018
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036468A207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000006140OtherMPLAN
IN000000092733OtherANTHEM
IN100337850AMedicaid
E26958Medicare UPIN
679710UMedicare ID - Type Unspecified
IN100337850AMedicaid