Healthcare Provider Details

I. General information

NPI: 1528063427
Provider Name (Legal Business Name): JOHN RICHARD HLADIK D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 PLAZA DR STE H
COLUMBUS IN
47201
US

IV. Provider business mailing address

411 PLAZA DR STE H
COLUMBUS IN
47201-2918
US

V. Phone/Fax

Practice location:
  • Phone: 812-372-6274
  • Fax: 812-372-9357
Mailing address:
  • Phone: 812-372-6274
  • Fax: 812-372-9357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00700873
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: