Provider Demographics
NPI:1326270273
Name:STEVEN K. GUDEMAN, MD PA
Entity Type:Organization
Organization Name:STEVEN K. GUDEMAN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-864-5550
Mailing Address - Street 1:2555 COURT DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2134
Mailing Address - Country:US
Mailing Address - Phone:704-864-5550
Mailing Address - Fax:704-864-7448
Practice Address - Street 1:1985 TATE BLVD SE
Practice Address - Street 2:SUITE 726
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1469
Practice Address - Country:US
Practice Address - Phone:828-322-2780
Practice Address - Fax:828-322-4870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35086207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911665Medicaid
NC5911665Medicaid
NCB60185Medicare UPIN