Provider Demographics
NPI:1477747459
Name:DUDLEY, MARY HELEN (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HELEN
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:HELEN
Other - Last Name:NICODEMUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7875 W 118TH PL
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2546
Mailing Address - Country:US
Mailing Address - Phone:913-499-1520
Mailing Address - Fax:913-499-1521
Practice Address - Street 1:660 E 24TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2606
Practice Address - Country:US
Practice Address - Phone:816-881-6600
Practice Address - Fax:816-404-1345
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001010857207ZF0201X
MO207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology