Provider Demographics
NPI:1154350718
Name:KADYK, JAN MARC (MD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:MARC
Last Name:KADYK
Suffix:
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 1:194 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5000
Mailing Address - Country:US
Mailing Address - Phone:828-264-1100
Mailing Address - Fax:828-264-0113
Practice Address - Street 1:194 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5000
Practice Address - Country:US
Practice Address - Phone:828-264-1100
Practice Address - Fax:828-264-0113
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21278207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8947748Medicaid
C89366Medicare UPIN
207709Medicare ID - Type Unspecified