MEDICARE: BRIAN W ONDULICK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	34-00-7860-O	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336129485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN W ONDULICK DO

Provider Business Mailing Address
First Line	:	3535 PENTAGON BLVD
Second Line	:	SUITE 320
City	:	BEAVERCREEK
State	:	OH
Zip	:	45431-1705
Country	:	US
Telephone Number	:	937-490-2270
Fax Number	:	937-490-2272

Provider Business Practice Location Address
First Line	:	3535 PENTAGON BLVD
Second Line	:	SUITE 320
City	:	BEAVERCREEK
State	:	OH
Zip	:	45431-1705
Country	:	US
Telephone Number	:	937-490-2270
Fax Number	:	937-490-2272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	01/07/2021

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Directions to “ BRIAN W ONDULICK DO” Practice Location

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