Provider Demographics
NPI:1114162690
Name:SUDIMAK, VINCENT LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:LOUIS
Last Name:SUDIMAK
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 1:454 STURGEON DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-4310
Mailing Address - Country:US
Mailing Address - Phone:330-715-9358
Mailing Address - Fax:
Practice Address - Street 1:201 FIFTH STREET NE STE 2
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-1619
Practice Address - Country:US
Practice Address - Phone:330-475-1616
Practice Address - Fax:330-475-1617
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.014.184208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery