Provider Demographics
NPI:1437224763
Name:STEMPEK, MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:STEMPEK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 N MAIN ST
Mailing Address - Street 2:AGAPE PRIMARY CARE
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1824
Mailing Address - Country:US
Mailing Address - Phone:401-331-8555
Mailing Address - Fax:401-751-3512
Practice Address - Street 1:1195 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1824
Practice Address - Country:US
Practice Address - Phone:401-331-8555
Practice Address - Fax:401-751-3512
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00519363A00000X
NY001516363A00000X
MA2271363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD5553Medicare ID - Type Unspecified
S73027Medicare UPIN