Organization Name: | KOLODZIK PHYSICIAN SERVICES, LLC |
NPI Number: | 1902264351 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAUL W. KOLODZIK (OWNER) |
Mailing Address: | 1108 Paxon Ct Bellbrook |
State: | OH US |
Postal Code: | 453058959 |
Phone Number: | 9378256220 |
Fax Number: | |
NPI Enumeration Date: | 01/31/2016 |
NPI Last Update Date: | 01/31/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 35052684 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |