Provider Demographics
NPI:1629483508
Name:KEDROWSKI, MARY RATLIFF (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:RATLIFF
Last Name:KEDROWSKI
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:3140 NW MEDICAL CENTER LN STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4735
Mailing Address - Country:US
Mailing Address - Phone:386-755-6682
Mailing Address - Fax:386-755-6796
Practice Address - Street 1:3140 NW MEDICAL CENTER LN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4717
Practice Address - Country:US
Practice Address - Phone:386-755-6682
Practice Address - Fax:386-755-6796
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2023-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS15936208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS15936Medicaid