Provider Demographics
NPI:1902846025
Name:CHUDOMELKA, PATRICIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:J
Last Name:CHUDOMELKA
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:PO BOX 30029
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-1129
Mailing Address - Country:US
Mailing Address - Phone:402-978-5156
Mailing Address - Fax:402-341-3616
Practice Address - Street 1:11819 MIRACLE HILLS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4428
Practice Address - Country:US
Practice Address - Phone:402-978-5156
Practice Address - Fax:402-341-3616
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20620208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081215600Medicaid
IA0515882Medicaid
NE270332Medicare ID - Type Unspecified
NEF44681Medicare UPIN
IA0515882Medicaid