Provider Demographics
NPI:1811069230
Name:PAWLAK, EUGENE S (DPM)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:S
Last Name:PAWLAK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 DEMAREE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-4622
Mailing Address - Country:US
Mailing Address - Phone:812-265-5200
Mailing Address - Fax:812-265-5207
Practice Address - Street 1:160 DEMAREE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-4622
Practice Address - Country:US
Practice Address - Phone:812-265-5200
Practice Address - Fax:812-265-5207
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA07000709A213E00000X, 213EP1101X
IN07000709A213ER0200X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Not Answered213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
Not Answered213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Not Answered213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT87383Medicare UPIN
IN412110Medicare ID - Type UnspecifiedPROVIDER #