Provider Demographics
NPI:1063496917
Name:WLODYKA, LANA E (MD)
Entity Type:Individual
Prefix:DR
First Name:LANA
Middle Name:E
Last Name:WLODYKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2141 E. CAMELBACK RD. STE. 210
Mailing Address - Street 2:VHA INTERIM STAFFING PROGRAM
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85106-0000
Mailing Address - Country:US
Mailing Address - Phone:904-389-9350
Mailing Address - Fax:
Practice Address - Street 1:2141 E CAMELBACK RD STE 210
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4765
Practice Address - Country:US
Practice Address - Phone:602-626-7528
Practice Address - Fax:602-761-5552
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 64899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE62271Medicare UPIN