Provider Demographics
NPI:1518040054
Name:MICHAEL J HAYDUK DDS MSD PC
Entity Type:Organization
Organization Name:MICHAEL J HAYDUK DDS MSD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAYDUK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:219-872-3232
Mailing Address - Street 1:450 ST JOHN ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7347
Mailing Address - Country:US
Mailing Address - Phone:219-872-3232
Mailing Address - Fax:219-872-3583
Practice Address - Street 1:450 ST JOHN ROAD
Practice Address - Street 2:SUITE 350
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7347
Practice Address - Country:US
Practice Address - Phone:219-872-3232
Practice Address - Fax:219-872-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120085301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty