Provider Demographics
NPI:1023013737
Name:HAIDUKEWYCH, GEORGE JOHN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JOHN
Last Name:HAIDUKEWYCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 W COPELAND DR
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2028
Mailing Address - Country:US
Mailing Address - Phone:407-649-6878
Mailing Address - Fax:407-843-7381
Practice Address - Street 1:89 W COPELAND DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2028
Practice Address - Country:US
Practice Address - Phone:407-649-6878
Practice Address - Fax:407-843-7381
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75428207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2915522OtherAVMED
FL268409800Medicaid
FL8164744OtherCIGNA
FL82052OtherBCBS OF FL
FL5211045OtherAETNA
FLP00201358OtherRAILROAD MEDICARE
FL268409800Medicaid
FL8164744OtherCIGNA
FL5211045OtherAETNA
FLE0420ZMedicare PIN