Provider Demographics
NPI:1487814273
Name:MUDY, KAROL (MD)
Entity Type:Individual
Prefix:
First Name:KAROL
Middle Name:
Last Name:MUDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-812-7800
Mailing Address - Fax:501-812-7777
Practice Address - Street 1:9601 BAPTIST HEALTH DR STE 990
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6376
Practice Address - Country:US
Practice Address - Phone:501-223-2860
Practice Address - Fax:501-223-2258
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58985208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400234153Medicare PIN