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General NPI Number Information
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NPI Number | 1609493964
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Entity Type | Individual
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Provider Name | ALEXANDER W. HODULIK PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 12/07/2024
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Provider Practice Location Address
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Address Line | 6821 PALISADES PARK CT STE 1
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City | FORT MYERS
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State | FL
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Zip | 33912-7131
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Country | US
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Telephone | 239-936-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 17226 ASHCOMB WAY
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City | ESTERO
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State | FL
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Zip | 33928-6472
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Country | US
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Telephone |
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | PA9113326
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9113326
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License Number State | FL
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