Provider Demographics
NPI:1295117653
Name:SUDEKUM, VERONICA (MD)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:
Last Name:SUDEKUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SUTHERLIN DR # C-1
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2259
Mailing Address - Country:US
Mailing Address - Phone:478-287-6144
Mailing Address - Fax:
Practice Address - Street 1:114 SUTHERLIN DR # C-1
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2259
Practice Address - Country:US
Practice Address - Phone:478-287-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA263324207R00000X
GA88412081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine