Healthcare Provider Details

I. General information

NPI: 1801722178
Provider Name (Legal Business Name): OBSIDIAN HEALTH MANAGEMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 CYPRESS POND RD APT 1613
PALM HARBOR FL
34683-1507
US

IV. Provider business mailing address

2350 CYPRESS POND RD APT 1613
PALM HARBOR FL
34683-1507
US

V. Phone/Fax

Practice location:
  • Phone: 813-609-0552
  • Fax:
Mailing address:
  • Phone: 813-609-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RAJIV MICHAEL DAVID HUDEK
Title or Position: MANAGING MEMBER
Credential:
Phone: 629-326-0415