Provider Demographics
NPI:1013094382
Name:KUDALKAR, PRASAD R (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:R
Last Name:KUDALKAR
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 1:5053 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-2326
Mailing Address - Country:US
Mailing Address - Phone:513-751-2145
Mailing Address - Fax:513-751-2138
Practice Address - Street 1:3050 MACK RD STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5376
Practice Address - Country:US
Practice Address - Phone:513-751-2273
Practice Address - Fax:513-751-1840
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089286207RH0003X, 207RH0003X
AZ33064207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2762685Medicaid
IN201041210Medicaid
KY7100178540Medicaid
OH2762685Medicaid
OHH037090Medicare PIN
OH2762685Medicaid
NV00100504947Medicaid