Healthcare Provider Details

I. General information

NPI: 1306840376
Provider Name (Legal Business Name): PAUL F. HUDZIK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E STATE ST STE 120
ALLIANCE OH
44601-4309
US

IV. Provider business mailing address

PO BOX 2718
ALLIANCE OH
44601-0718
US

V. Phone/Fax

Practice location:
  • Phone: 330-823-8452
  • Fax: 330-823-8491
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34-006856
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: