Healthcare Provider Details

I. General information

NPI: 1033214358
Provider Name (Legal Business Name): WALTER MICHAEL KOBIALKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 SUMMER ST STE 102
STAMFORD CT
06905-5315
US

IV. Provider business mailing address

219 BRANCH BROOK RD
WILTON CT
06897-1804
US

V. Phone/Fax

Practice location:
  • Phone: 203-325-0764
  • Fax: 203-325-0865
Mailing address:
  • Phone: 203-762-8562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number135661
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: