Healthcare Provider Details

I. General information

NPI: 1669443404
Provider Name (Legal Business Name): BUCKEYE UROLOGY AND ANDROLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5969 E BROAD ST STE 407
COLUMBUS OH
43213-1546
US

IV. Provider business mailing address

5969 E BROAD ST STE 407
COLUMBUS OH
43213-1546
US

V. Phone/Fax

Practice location:
  • Phone: 614-864-2426
  • Fax: 614-575-0054
Mailing address:
  • Phone: 614-864-2426
  • Fax: 614-575-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ANDREW WODARCYK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 614-864-2426