Healthcare Provider Details

I. General information

NPI: 1215002753
Provider Name (Legal Business Name): MICHAEL B HAJDUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 POWELL ST STE 400
EMERYVILLE CA
94608-1872
US

IV. Provider business mailing address

2100 POWELL ST STE 400
EMERYVILLE CA
94608-1872
US

V. Phone/Fax

Practice location:
  • Phone: 510-851-7501
  • Fax: 510-851-7446
Mailing address:
  • Phone: 510-851-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA84931
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA84931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: