Healthcare Provider Details

I. General information

NPI: 1316308729
Provider Name (Legal Business Name): MICHAEL WOJDAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

5955 ZEAMER AVE
ANCHORAGE AK
99506-3702
US

V. Phone/Fax

Practice location:
  • Phone: 937-395-8166
  • Fax:
Mailing address:
  • Phone: 907-580-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number2115
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number2020011738
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number194553
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number194553
License Number StateAK
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.017319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: