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General NPI Number Information
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NPI Number | 1831194919
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Entity Type | Individual
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Provider Name | JOHN ANTHONY HUDAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 6301 UNIVERSITY COMMONS STE 350
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City | SOUTH BEND
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State | IN
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Zip | 46635-1571
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Country | US
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Telephone | 574-234-4100
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Fax | 574-282-1739
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Provider Business Mailing Address
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Address Line | 211 N EDDY ST
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City | SOUTH BEND
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State | IN
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Zip | 46617-3096
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Country | US
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Telephone | 574-234-4100
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 01033777A
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License Number State | IN
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