Michael J Hayduk, DDS MS D

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

12008530 Issued in IN

Practice address

450 St John Road
Suite 350
Michigan City, IN 46360-7347

Phone

(219) 872-3232

Fax

(219) 872-3583

NPI assigned

Oct 19, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michael J Hayduk DDS MSD PC

  • Periodontics
  • Michigan City, IN
  • NPI 1518040054
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421366400000",
    "number": "1114009057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 ST JOHN ROAD",
            "address_2": "SUITE 350",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463607347",
            "telephone_number": "219-872-3232",
            "fax_number": "219-872-3583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 ST JOHN ROAD",
            "address_2": "SUITE 350",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463607347",
            "telephone_number": "219-872-3232",
            "fax_number": "219-872-3583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYDUK",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "DDS MS D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2015-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IN",
            "license": "12008530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Michigan City, IN
• Periodontics in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.