Provider Demographics
NPI:1437454162
Name:RICHARD W KUDREWICZ, MD LTD
Entity Type:Organization
Organization Name:RICHARD W KUDREWICZ, MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:KUDREWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-877-9676
Mailing Address - Street 1:2820 W. CHARLESTON BLVD.
Mailing Address - Street 2:C-27
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1942
Mailing Address - Country:US
Mailing Address - Phone:702-877-9676
Mailing Address - Fax:702-878-2119
Practice Address - Street 1:2820 W. CHARLESTON BLVD.
Practice Address - Street 2:C-27
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1942
Practice Address - Country:US
Practice Address - Phone:702-877-9676
Practice Address - Fax:702-878-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty