Provider Demographics
NPI:1841269057
Name:DUCHAK, JOHN M III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:DUCHAK
Suffix:III
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 1:4000 MIAMISBURG CENTERVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7615
Mailing Address - Country:US
Mailing Address - Phone:937-866-0637
Mailing Address - Fax:937-866-6713
Practice Address - Street 1:1126 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2687
Practice Address - Country:US
Practice Address - Phone:937-223-3053
Practice Address - Fax:937-463-1765
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.064642207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110077875OtherRAILROAD MEDICARE
OH0952518Medicaid
OH0743232Medicare PIN
OHH461780Medicare PIN
OH110077875OtherRAILROAD MEDICARE