Provider Demographics
NPI:1942395215
Name:WUDEL, JAMES H (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:WUDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-567-4311
Mailing Address - Fax:
Practice Address - Street 1:1000 36TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4862
Practice Address - Country:US
Practice Address - Phone:772-567-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE204902086S0129X, 208G00000X
SD12243208G00000X
FLME147149208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100300950AMedicaid
NE47070592306Medicaid
NE10026072500Medicaid
NE47070592300Medicaid
NE10026072400Medicaid
NE47070592305Medicaid
NE10026072300Medicaid
NE47070592301Medicaid
NE10026072600Medicaid
NE47070592302Medicaid
NE47070592313Medicaid
NE10026072300Medicaid
NE10026072400Medicaid
KS100300950AMedicaid
NE47070592306Medicaid
NE47070592313Medicaid
IA0537241Medicaid
NE47070592301Medicaid
NENA1939028Medicare PIN
F19849Medicare UPIN