Provider Demographics
NPI:1669405213
Name:BADIK, BRYAN J (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:J
Last Name:BADIK
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 1:1601 BRIGHAM DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7114
Mailing Address - Country:US
Mailing Address - Phone:419-872-5863
Mailing Address - Fax:419-872-3015
Practice Address - Street 1:1601 BRIGHAM DR
Practice Address - Street 2:SUITE 250
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7114
Practice Address - Country:US
Practice Address - Phone:419-872-5863
Practice Address - Fax:419-872-3015
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2665370Medicaid
OH000000485304OtherANTHEM
OH06185OtherPARAMOUNT
OH7449837OtherAETNA
OH279820172OtherTRICARE
OH279820172-001OtherMMOH
OHP00325743OtherRRMC
OHBA4187651Medicare PIN
OH000000485304OtherANTHEM