Provider Demographics
NPI:1538149208
Name:WODKA, MICHAEL L (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:WODKA
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 1:30 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-1662
Mailing Address - Country:US
Mailing Address - Phone:845-692-3338
Mailing Address - Fax:
Practice Address - Street 1:30 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-1662
Practice Address - Country:US
Practice Address - Phone:845-692-3338
Practice Address - Fax:845-692-5549
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003161-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00554738Medicaid
NYT50978Medicare UPIN
NYPH7821Medicare PIN