Basic Information
| Provider Information | |||||||||
| NPI: | 1114162690 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUDIMAK | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | LOUIS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 454 STURGEON DR | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443194310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307159358 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 FIFTH STREET NE STE 2 | ||||||||
| Address2: | |||||||||
| City: | BARBERTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442031619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304751616 | ||||||||
| FaxNumber: | 3304751617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2008 | ||||||||
| LastUpdateDate: | 08/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 57.014.184 | OH | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.