Provider Demographics
NPI:1508846551
Name:ALEX R. CUDKOWICZ, M.D.,P.C.
Entity Type:Organization
Organization Name:ALEX R. CUDKOWICZ, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ATHANASSIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPAIOANU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-916-3200
Mailing Address - Street 1:658 GRASSMERE PARK STE 104
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3683
Mailing Address - Country:US
Mailing Address - Phone:615-916-3217
Mailing Address - Fax:615-916-3218
Practice Address - Street 1:1011 N MILDRED RD
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321
Practice Address - Country:US
Practice Address - Phone:970-565-8482
Practice Address - Fax:970-565-8478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34477207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06D2089339OtherCLIA
UT291602679011Medicaid
AZ445066Medicaid
NMQ4652Medicaid
CO21901OtherBLUE CROSS/BLUE SHIELD ID
CO74779354Medicaid
NMQ4652Medicaid