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NPI Code Detail

MEDICARE: DR. MITCHELL L WIATRAK MD

MEDICARE: DR. MITCHELL L WIATRAK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician42456KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114914900
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MITCHELL L WIATRAK MD
Provider Business Mailing Address
First Line : 310 N L ROGERS WELLS BLVD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-1300
Country : US
Telephone Number : 270-659-5965
Fax Number : 270-659-5856
Provider Business Practice Location Address
First Line : 310 N L ROGERS WELLS BLVD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-1300
Country : US
Telephone Number : 270-659-5965
Fax Number : 270-659-5856
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 03/07/2023

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