Individual
MARY WADIKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4150
Mailing address
629 N SANDUSKY AVE, BUCYRUS, OH 44820-1821
(800) 875-0136
(937) 619-4150
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34003727
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000026809
ANTHEM
—
05
—
0569988
—
OH
01
—
341407259
NATIONWIDE
—
01
—
341407259037
MEDICAL MUTUAL
—
01
—
7755544
AETNA
—
01
—
87726
UHC
—
01
—
930068048
RR MEDICARE
—
01
—
WA7250981
TRICARE
—
Enumeration date
06/11/2006
Last updated
03/21/2013
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