Provider Demographics
NPI:1225027014
Name:KUDELKO, PAUL EDWARD II (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDWARD
Last Name:KUDELKO
Suffix:II
Gender:M
Credentials:DO
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Mailing Address - Street 1:353 NEW SHACKLE ISLAND RD
Mailing Address - Street 2:SUITE 300C
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2379
Mailing Address - Country:US
Mailing Address - Phone:615-824-0043
Mailing Address - Fax:615-822-1690
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD
Practice Address - Street 2:SUITE 300C
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2379
Practice Address - Country:US
Practice Address - Phone:615-824-0043
Practice Address - Fax:615-822-1690
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2022-02-01
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNDO 2430207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530417Medicaid
G15153Medicare UPIN
TN1530417Medicaid