DR. FRED J KUDRIK (NPI# 1104807668) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104807668 |
| Entity Type | Individual |
| Full Name | DR. FRED J KUDRIK |
| Credential | MD |
| Practice Address |
166 Stoneridge Dr Columbia SC 29210-8239 |
| Mailing Address |
Po Box 2046 West Columbia SC 29171-2046 |
| Practice Telephone | 8034613000 |
| Practice Fax Number | 8034614910 |
| Mailing Telephone | 8034613000 |
| Mailing Fax Number | 8034614910 |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2009-11-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
22933 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | MCARE GROUP# | 6275 | 01 |
| SC | 229336 | 05 |
| Street Address |
166 STONERIDGE DR |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29210-8239 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912988536 | Mary Audrey Ackerman | Internal Medicine | 166 Stoneridge Dr, Columbia, SC 29210-8239 | 2005-11-10 |
| 1154808525 | Savannah Roof | Physician Assistant | 166 Stoneridge Dr, Columbia, SC 29210-8239 | 2018-07-27 |
| 1467893891 | Kitra Nichols | Nurse Practitioner | 166 Stoneridge Dr, Columbia, SC 29210-8239 | 2013-07-15 |
| 1467899534 | Leonid Zamdborg | Radiology | 166 Stoneridge Dr, Columbia, SC 29210-8239 | 2013-05-30 |
| 1174864466 | Shelly K Goins | Nurse Practitioner | 166 Stoneridge Dr, Columbia, SC 29210-8239 | 2013-03-12 |
| 1629317920 | Ijan W House | Nurse Practitioner | 166 Stoneridge Dr, Columbia, SC 29210-8239 | 2013-02-06 |
| 1568725810 | Kevin Blas | Radiology | 166 Stoneridge Dr, Columbia, SC 29210-8239 | 2012-06-21 |
| 1467719732 | Amy Furmanski Ballou | Nurse Practitioner | 166 Stoneridge Dr, Columbia, SC 29210-8239 | 2012-04-11 |
| 1962799452 | Kurt Davin Meyer | Radiology | 166 Stoneridge Dr, Columbia, SC 29210-8239 | 2011-07-05 |
| 1639475098 | Garland Pearson Ames | Nurse Practitioner | 166 Stoneridge Dr, Columbia, SC 29210-8239 | 2011-02-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700413838 | Alexis Koreema Brown | Social Worker | 3205 Montcrest Rd., Columbia, SC 29210 | 2020-03-26 |
| 1942767843 | Thomas Edwin Cromer | Social Worker | 409 Evelyn Drive, Columbia, SC 29210 | 2019-02-27 |
| 1184193542 | Helen Hoffman Coleman | Pharmacist | 16 Berryhill Road, Ste 109, Columbia, SC 29210 | 2018-11-15 |
| 1356828040 | Latia Kelly Mcdonald | Counselor | 105 Beth Hope Lane, Columbia, SC 29210 | 2018-07-25 |
| 1356892848 | Butterfly Effects LLC | Community/Behavioral Health | 1607 Bentley Court, Columbia, SC 29210 | 2016-10-19 |
| 1114373651 | Lilian Emetu | Nurse Practitioner | 822 Statler Road, Columbia, SC 29210 | 2016-05-13 |
| 1154776433 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 507 Piney Grove Rd, Columbia, SC 29210 | 2016-04-25 |
| 1790167690 | Wanda Al-lahabi | Specialist | 1030 St. Andrews Rd., Suite B-3, Columbia, SC 29210 | 2015-06-26 |
| 1285040279 | Debra R. Smart | Counselor | 652 Bush Road, Suite 216, Columbia, SC 29210 | 2014-07-10 |
| 1144665282 | Snf Transportation LLC | Home Health | 810 Dutch Center Blvd, Columbia, SC 29210 | 2013-05-02 |
| Find all providers in zip 29210 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912988536 | Mary Audrey Ackerman | Internal Medicine | 166 Stoneridge Dr, Columbia, SC 29210-8239 | 2005-11-10 |
| 1356322812 | Robert E Smith Jr. | Internal Medicine | 166 Stoneridge Drive, Columbia, SC 29210 | 2005-11-10 |
| 1568886273 | Columbia Comprehensive Cancer Care Clinic | Internal Medicine | 500 N Keene St, Suite 202, Columbia, MO 65201-8104 | 2014-02-17 |
| 1952657462 | Jaffar Hilli | Internal Medicine | One Hospital Drive, Columbia, MO 65212-0001 | 2012-08-02 |
| 1851654818 | Andrew Mcmorris Iliff | Internal Medicine | 1705 E Broadway Ste 100, Columbia, MO 65201 | 2012-06-24 |
| 1902196165 | Varun Choudary Dhulipala | Internal Medicine | 1224 Trotwood Ave, Columbia, TN 38401-4802 | 2011-04-08 |
| 1891084513 | Andrew Scott Mener | Internal Medicine | 10710 Charter Dr, Columbia, MD 21044-3128 | 2011-04-04 |
| 1730495250 | Liana Makarian | Internal Medicine | 1705 E Broadway, Columbia, MO 65201-7166 | 2010-08-21 |
| 1821271032 | Maryland Oncology Hematology, P.a. | Internal Medicine | 10710 Charter Dr, Suite G020, Columbia, MD 21044-3128 | 2007-12-11 |
| 1922205681 | Amruth Palla | Internal Medicine | 1 Hospital Dr, Columbia, MO 65212-0001 | 2007-06-27 |
| Find all providers in COLUMBIA | ||||
Please comment or provide details below to improve the information on DR. FRED J KUDRIK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.