MEDICARE: BUCKEYE UROLOGY AND ANDROLOGY, INC

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1669443404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKEYE UROLOGY AND ANDROLOGY, INC

Provider Business Mailing Address
First Line	:	5969 E BROAD ST
Second Line	:	STE 407
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1546
Country	:	US
Telephone Number	:	614-864-2426
Fax Number	:	614-575-0054

Provider Business Practice Location Address
First Line	:	5969 E BROAD ST
Second Line	:	STE 407
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1546
Country	:	US
Telephone Number	:	614-864-2426
Fax Number	:	614-575-0054

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL ANDREW WODARCYK
Credential	:	M.D.
Telephone Number	:	614-864-2426

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	08/22/2020

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