Provider Demographics
NPI:1770103665
Name:HUDAK, MADELINE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:HUDAK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 3RD ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1607
Mailing Address - Country:US
Mailing Address - Phone:330-754-4431
Mailing Address - Fax:330-244-8839
Practice Address - Street 1:236 3RD ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1607
Practice Address - Country:US
Practice Address - Phone:330-754-4431
Practice Address - Fax:330-244-8839
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.031728207R00000X
OH34.016478207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty