Provider Demographics
NPI:1356539084
Name:CUDKOWICZ, ALEX RAIMES (MD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:RAIMES
Last Name:CUDKOWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 N MILDRED RD
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2435
Mailing Address - Country:US
Mailing Address - Phone:970-565-8482
Mailing Address - Fax:970-565-8478
Practice Address - Street 1:1011 N MILDRED RD
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2435
Practice Address - Country:US
Practice Address - Phone:970-565-8482
Practice Address - Fax:970-565-8478
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34477207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01344779Medicaid
NMQ4652OtherNEW MEXICO MEDICAID
G46911Medicare UPIN
C21901Medicare PIN