Provider Demographics
NPI:1932101169
Name:HRADEK, DALIBOR IRWING (MD)
Entity Type:Individual
Prefix:DR
First Name:DALIBOR
Middle Name:IRWING
Last Name:HRADEK
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:PO BOX 499
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-0499
Mailing Address - Country:US
Mailing Address - Phone:941-708-7669
Mailing Address - Fax:941-708-8893
Practice Address - Street 1:1312 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1358
Practice Address - Country:US
Practice Address - Phone:941-708-7669
Practice Address - Fax:941-708-8893
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062245174400000X
FLME98647207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04862OtherBCBS
OH0238844Medicaid
FL279403900Medicaid
FL04862OtherBCBS
OH9282221Medicare ID - Type Unspecified
OH0238844Medicaid