Provider Demographics
NPI:1780629741
Name:BADYLAK, JOHN STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:STEPHEN
Last Name:BADYLAK
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 1:3025 N TARRANT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8629
Mailing Address - Country:US
Mailing Address - Phone:817-697-3900
Mailing Address - Fax:817-562-8530
Practice Address - Street 1:2 SCIENCE CT
Practice Address - Street 2:UNIV. OF WI HOSPITAL AND CLINICS ROOM H4/831-8320
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1088
Practice Address - Country:US
Practice Address - Phone:608-231-3410
Practice Address - Fax:608-231-3430
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51679-20207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery