MEDICARE: DR. DANIEL ROBERT HUDAK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD-14465	HI

General Provider Information

NPI Number	:	1003010265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL ROBERT HUDAK M.D.

Provider Business Mailing Address
First Line	:	73 PUUHONU PL STE 108
Second Line	:
City	:	HILO
State	:	HI
Zip	:	96720-2060
Country	:	US
Telephone Number	:	808-934-2009
Fax Number	:	808-934-2041

Provider Business Practice Location Address
First Line	:	134 PUUHONU WAY APT B
Second Line	:
City	:	HILO
State	:	HI
Zip	:	96720-2066
Country	:	US
Telephone Number	:	808-961-0655
Fax Number	:	808-935-0904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	08/06/2008

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