Basic Information
| Provider Information | |||||||||
| NPI: | 1003079138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEDELKA | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 WATER ST | ||||||||
| Address2: | SUITE J-100 | ||||||||
| City: | KERRVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780283523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302573131 | ||||||||
| FaxNumber: | 8302573161 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 WATER ST | ||||||||
| Address2: | SUITE J-100 | ||||||||
| City: | KERRVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780283523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302573131 | ||||||||
| FaxNumber: | 8302573161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2008 | ||||||||
| LastUpdateDate: | 11/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 0116020811 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0001X | P7521 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.