Basic Information
| Provider Information | |||||||||
| NPI: | 1003800103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SZPAK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | WALTER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SZPAK | ||||||||
| OtherFirstName: | MICHAEL | ||||||||
| OtherMiddleName: | W | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1009 N MONROE ST | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317011970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298830298 | ||||||||
| FaxNumber: | 2294387898 | ||||||||
| Practice Location | |||||||||
| Address1: | 1009 N MONROE ST | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317011903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298830298 | ||||||||
| FaxNumber: | 2294387898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2005 | ||||||||
| LastUpdateDate: | 11/30/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 034256 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.