Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 50968 | TN |
Y | 207RP1001X | Pulmonary Disease | 50968 | TN |
NPI | 1003012022 |
---|---|
Provider Name | Corey Cudzilo |
First Address | Oklahoma City, OK 73143-4670 |
Second Address | Knoxville, TN 37919-2333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 14/05/2019 |