Provider Demographics
NPI:1003800103
Name:SZPAK, MICHAEL WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WALTER
Last Name:SZPAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:W
Other - Last Name:SZPAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1009 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1970
Mailing Address - Country:US
Mailing Address - Phone:229-883-0298
Mailing Address - Fax:229-438-7898
Practice Address - Street 1:1009 N MONROE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1903
Practice Address - Country:US
Practice Address - Phone:229-883-0298
Practice Address - Fax:229-438-7898
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034256207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAA79984Medicare UPIN
511G701098Medicare PIN