Provider Demographics
NPI:1689666265
Name:FURDIK, VILIAM JESUS (MD)
Entity Type:Individual
Prefix:
First Name:VILIAM
Middle Name:JESUS
Last Name:FURDIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1112 LINDEN AVE
Mailing Address - Street 2:204
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3378
Mailing Address - Country:US
Mailing Address - Phone:818-972-2867
Mailing Address - Fax:818-972-2862
Practice Address - Street 1:255 E SANTA CLARA ST
Practice Address - Street 2:230
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7226
Practice Address - Country:US
Practice Address - Phone:626-447-7144
Practice Address - Fax:626-447-7145
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA533362084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF09728Medicare UPIN
CAWA53336AMedicare ID - Type Unspecified