Provider Demographics
NPI:1356887913
Name:WUDYKA, EDWIN
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:WUDYKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44004 WOODWARD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5031
Mailing Address - Country:US
Mailing Address - Phone:248-952-9944
Mailing Address - Fax:
Practice Address - Street 1:44004 WOODWARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5031
Practice Address - Country:US
Practice Address - Phone:248-952-9944
Practice Address - Fax:248-952-9947
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1356887913OtherNPI