Individual
JOHN CHARLES WODYNSKI JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1400 S LAKE PARK AVE STE 200-202, HOBART, IN 46342-6790
(219) 947-6122
Mailing address
1400 S. LAKE PARK AVENUE, SUITE 200, HOBART, IN 46342-6791
(219) 947-6122
(219) 947-6045
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001589A
IN
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
12/21/2011
Last updated
02/05/2020
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