Provider Demographics
NPI:1528063427
Name:HLADIK, JOHN RICHARD (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:HLADIK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 PLAZA DR STE H
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2918
Mailing Address - Country:US
Mailing Address - Phone:812-372-6274
Mailing Address - Fax:812-372-9357
Practice Address - Street 1:411 PLAZA DR STE H
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201
Practice Address - Country:US
Practice Address - Phone:812-372-6274
Practice Address - Fax:812-372-9357
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN00700873213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
480030668OtherRAILROAD MEDICARE
IN200183180AMedicaid
IN352059940OtherWORKERS COMPENSATION
IN000000093267OtherBLUE SHIELD
IN000000093267OtherBLUE SHIELD
480030668OtherRAILROAD MEDICARE