Provider Demographics
NPI:1407600570
Name:MARLA W DUDAK MD PC
Entity Type:Organization
Organization Name:MARLA W DUDAK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:W
Authorized Official - Last Name:DUDAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-706-7004
Mailing Address - Street 1:PO BOX 150610
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415-0610
Mailing Address - Country:US
Mailing Address - Phone:801-476-9200
Mailing Address - Fax:801-476-9208
Practice Address - Street 1:1220 E 3900 S STE 4I
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1383
Practice Address - Country:US
Practice Address - Phone:801-948-2380
Practice Address - Fax:801-948-2385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty