Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 2800 | OH |
NPI | 1598886053 |
---|---|
Provider Name | Ms. Donna Marie Hradisky |
First Address | Richfield, OH 44286-9486 |
Second Address | Richfield, OH 44286-9486 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |