Provider Demographics
NPI:1205360161
Name:ANN M. HUDACEK, DPM INC
Entity Type:Organization
Organization Name:ANN M. HUDACEK, DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-648-1011
Mailing Address - Street 1:1011 CASS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4532
Mailing Address - Country:US
Mailing Address - Phone:831-648-1011
Mailing Address - Fax:831-648-1034
Practice Address - Street 1:1011 CASS ST STE 201
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4532
Practice Address - Country:US
Practice Address - Phone:831-648-1011
Practice Address - Fax:831-648-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3903213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU47032Medicare UPIN