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General NPI Number Information
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NPI Number | 1215005087
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Entity Type | Individual
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Provider Name | MARK J. HUDAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 02/23/2011
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Provider Practice Location Address
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Address Line | 1811 SCHNEIDER ST NE MERCY HEALTH CENTER
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City | CANTON
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State | OH
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Zip | 44721-3349
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Country | US
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Telephone | 330-588-4884
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Fax | 330-494-6484
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Provider Business Mailing Address
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Address Line | 10963 WOLF AVENUE NE
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City | HARTVILLE
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State | OH
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Zip | 44632
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Country | US
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Telephone | 330-877-8498
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35-063048
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 35063048
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License Number State | OH
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