NPIMap

Individual provider Active NPI

Paul Walter Haduck, DO

  • Family Medicine Physician
  • Munising, MI
National Provider Identifier
1679587174
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101010351 Issued in MI
Practice address
1500 Sandpoint Rd
Munising, MI 49862-1406
Phone
(906) 387-4338
Fax
(906) 387-2825
NPI assigned
Jul 28, 2006
Last updated
Mar 22, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X PH5101010351 MI
Family Medicine Physician 207Q00000X 5101010351 MI Primary

Addresses

Primary practice location

1500 Sandpoint Rd
Munising, MI 49862-1406

Mailing address

1500 Sandpoint Rd
Munising, MI 49862-1406
Phone (906) 387-4338

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121221000159 MI Practitioner - Family PracticePractitioner - General Practice 0042393142 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Munising Memorial Hospital AssociationGroup PAC ID 9830170372, shared by 3 NPIs, 14 clinicians

Practice addresses (Care Compare)

1500 Sandpoint Rd
Munising, MI 49862-1406
Phone (906) 387-4110

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
PH5101010351MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Opdyke Family Medical, P.C. Family Medicine Current Accepting new patients
Opdyke Medical, PLLC Current Accepting new patients
Munising Memorial Hospital Association Family Medicine CurrentSince Nov 16, 2017 Accepting new patients
Munising Memorial Hospital Association Current Accepting new patients
Munising Memorial Hospital Association Family Medicine CurrentSince Nov 16, 2017 Accepting new patients
SJMH Medical Practice-SMHC Past Accepting new patients
Munising Opco, LLC Past Accepting new patients

Locations

719 S Opdyke Rd
Auburn Hills, MI 48326
Phone (248) 333-2600

1500 Sandpoint Rd
Munising, MI 49862
Phone (906) 387-4110

1514 Sandpoint Rd
Munising, MI 49862
Phone (906) 387-4110

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10065479

Organizations & group practices 7

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

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1679587174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 SANDPOINT RD",
            "city": "MUNISING",
            "state": "MI",
            "postal_code": "498621406",
            "telephone_number": "906-387-4338",
            "fax_number": "906-387-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SANDPOINT RD",
            "city": "MUNISING",
            "state": "MI",
            "postal_code": "498621406",
            "telephone_number": "906-387-4338",
            "fax_number": "906-387-2825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADUCK",
        "first_name": "PAUL",
        "middle_name": "WALTER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "PH5101010351",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101010351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Munising, MI

Sources for this page

Verify at the official NPI Registry.