Provider Demographics
NPI:1790966463
Name:KUDEL, DAVID O I
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:O
Last Name:KUDEL
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 ALPENA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-6231
Mailing Address - Country:US
Mailing Address - Phone:614-833-6288
Mailing Address - Fax:
Practice Address - Street 1:3617 ALPENA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-6231
Practice Address - Country:US
Practice Address - Phone:614-833-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-125168164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse