Healthcare Provider Details

I. General information

NPI: 1023013737
Provider Name (Legal Business Name): GEORGE JOHN HAIDUKEWYCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 W COPELAND DR 3RD FLOOR
ORLANDO FL
32806-2028
US

IV. Provider business mailing address

89 W COPELAND DR 3RD FLOOR
ORLANDO FL
32806-2028
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-6878
  • Fax: 407-843-7381
Mailing address:
  • Phone: 407-649-6878
  • Fax: 407-843-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME75428
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME75428
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: