Provider Demographics
NPI:1588668289
Name:DOMBEK, MICHAEL F (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:DOMBEK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:265 N JEFF DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1668
Mailing Address - Country:US
Mailing Address - Phone:770-716-8732
Mailing Address - Fax:770-716-8878
Practice Address - Street 1:1975 HIGHWAY 54 W
Practice Address - Street 2:STE 205
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4794
Practice Address - Country:US
Practice Address - Phone:678-561-9000
Practice Address - Fax:770-487-1232
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA000954213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00975158AMedicaid
U89983Medicare UPIN
GA00975158AMedicaid