Provider Demographics
NPI:1518006873
Name:STEMPEK, MICHAEL PATRICK (PA-C, MMSC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:STEMPEK
Suffix:
Gender:M
Credentials:PA-C, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PRESIDENTIAL WAY
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1100
Mailing Address - Country:US
Mailing Address - Phone:781-782-1300
Mailing Address - Fax:781-782-1350
Practice Address - Street 1:150 PRESIDENTIAL WAY
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1100
Practice Address - Country:US
Practice Address - Phone:781-782-1300
Practice Address - Fax:781-782-1350
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4992363AS0400X
MAPA4497363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4788150001Medicare NSC