Healthcare Provider Details

I. General information

NPI: 1578178323
Provider Name (Legal Business Name): STEFAN GUDZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3569 RIDGE RD
CLEVELAND OH
44102-5443
US

IV. Provider business mailing address

3101 W US HIGHWAY 224
TIFFIN OH
44883-8305
US

V. Phone/Fax

Practice location:
  • Phone: 216-281-0872
  • Fax:
Mailing address:
  • Phone: 419-448-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: