Provider Demographics
NPI:1134284383
Name:REPIK, MICHAEL R (DO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:REPIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 W FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3103
Mailing Address - Country:US
Mailing Address - Phone:805-419-5667
Mailing Address - Fax:
Practice Address - Street 1:11 W FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3103
Practice Address - Country:US
Practice Address - Phone:805-419-5667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA)T010607207ZP0102X
CA20A12768208D00000X
NH14304208VP0014X
AZ5799208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine