Provider Demographics
NPI:1730173840
Name:HAUDENSCHILT, RONALD JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:HAUDENSCHILT
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 1:5770 KARL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3658
Mailing Address - Country:US
Mailing Address - Phone:614-847-9933
Mailing Address - Fax:614-847-9919
Practice Address - Street 1:5770 KARL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3658
Practice Address - Country:US
Practice Address - Phone:614-847-9933
Practice Address - Fax:614-847-9919
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0653896Medicaid
A82665Medicare UPIN
OHHA0595681Medicare ID - Type Unspecified