Provider Demographics
NPI:1174075196
Name:SUDIMAK, MARK A (CRNA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:SUDIMAK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 S HAMETOWN RD
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-2454
Mailing Address - Country:US
Mailing Address - Phone:330-524-9937
Mailing Address - Fax:
Practice Address - Street 1:4591 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-7376
Practice Address - Country:US
Practice Address - Phone:330-524-9937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH357443163W00000X
OH019368367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse