Provider Demographics
NPI:1033214358
Name:KOBIALKA, WALTER MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:MICHAEL
Last Name:KOBIALKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:219 BRANCH BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-1804
Mailing Address - Country:US
Mailing Address - Phone:203-762-8562
Mailing Address - Fax:
Practice Address - Street 1:1275 SUMMER ST STE 102
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5315
Practice Address - Country:US
Practice Address - Phone:203-325-0764
Practice Address - Fax:203-325-0865
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135661207QG0300X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine