Provider Demographics
NPI:1760422869
Name:KOLODZIK, PAUL W (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:KOLODZIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4231
Practice Address - Street 1:550 MIRABEAU ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-1617
Practice Address - Country:US
Practice Address - Phone:937-981-2216
Practice Address - Fax:937-981-9238
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35052684207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0608006Medicaid
OH000000537070OtherANTHEM
P00206144OtherRAIL ROAD MEDICARE
KY201007380Medicaid
P00111883OtherRAILROAD MEDICARE
000000329196OtherBLUE CROSS BLUE SHIELD
000000315973OtherBCBS FOR UVMC
OH000000316737OtherBCBS
OH000000351194OtherANTHEM BCBS/MARYSVILLE
OH000000531260OtherANTHEM
OHP00441746OtherMEDICARE RAILROAD
P00307842OtherRR MEDICARE FOR UVMC
OH000000537070OtherANTHEM
OH000000531260OtherANTHEM
000000315973OtherBCBS FOR UVMC
000000329196OtherBLUE CROSS BLUE SHIELD
OH4109359Medicare PIN
OHP00891164Medicare PIN
OH000000316737OtherBCBS
OH000000351194OtherANTHEM BCBS/MARYSVILLE