=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720253438
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL D BADIK DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2008
-----------------------------------------------------
Last Update Date | 05/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 W 4TH ST SUITE 100
-----------------------------------------------------
City | FOSTORIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44830-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-436-6680
-----------------------------------------------------
Fax | 419-436-6681
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 455 W 4TH ST SUITE 100
-----------------------------------------------------
City | FOSTORIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44830-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-436-6680
-----------------------------------------------------
Fax | 419-436-6681
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 34.009920
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------