Provider Demographics
NPI:1407827264
Name:WODARCYK, MICHAEL A (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:WODARCYK
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 1:701 TECH CENTER DR STE 250
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1987
Mailing Address - Country:US
Mailing Address - Phone:614-396-2684
Mailing Address - Fax:614-396-2480
Practice Address - Street 1:701 TECH CENTER DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1987
Practice Address - Country:US
Practice Address - Phone:614-396-2684
Practice Address - Fax:614-396-2480
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059868208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0803867Medicaid
OH0335453OtherRAILROAD MEDICARE
OH0674175Medicare PIN
OH0335453OtherRAILROAD MEDICARE