John Adam Obudzinski, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

21407-021 Issued in WI

Practice address

2424-S. 90TH St.
Ste 214
West Allis, WI 53227-2455

Phone

(414) 328-8777

Fax

(414) 328-8777

NPI assigned

Nov 1, 2006

Last updated

Nov 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. John Adam Obudzinski Professional name

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Interoperability endpoints

• Direct secure messaging: jobudzinski23552@direct.myadvocateaurora.org

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1942388434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100-15TH AVE.",
            "address_2": "STE 180",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531721160",
            "telephone_number": "414-768-5430",
            "fax_number": "414-762-4225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424-S. 90TH ST.",
            "address_2": "STE 214",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272455",
            "telephone_number": "414-328-8777",
            "fax_number": "414-328-8777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBUDZINSKI",
        "first_name": "JOHN",
        "middle_name": "ADAM",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101006817",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "21407-021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2424-S. 90th St.",
            "address_2": "Ste 214",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532272455",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jobudzinski23552@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "2424-S. 90th St.",
            "address_2": "Ste 214",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532272455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "OBUDZINSKI",
            "middle_name": "ADAM",
            "prefix": "DR.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Internal Medicine Physician in West Allis, WI
• Providers in West Allis, WI by specialty
• Internal Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.