Provider Demographics
NPI:1669443404
Name:BUCKEYE UROLOGY AND ANDROLOGY, INC
Entity Type:Organization
Organization Name:BUCKEYE UROLOGY AND ANDROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WODARCYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-864-2426
Mailing Address - Street 1:5969 E BROAD ST
Mailing Address - Street 2:STE 407
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1546
Mailing Address - Country:US
Mailing Address - Phone:614-864-2426
Mailing Address - Fax:614-575-0054
Practice Address - Street 1:5969 E BROAD ST
Practice Address - Street 2:STE 407
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1546
Practice Address - Country:US
Practice Address - Phone:614-864-2426
Practice Address - Fax:614-575-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BU9197873Medicare ID - Type Unspecified