Healthcare Provider Details

I. General information

NPI: 1376961326
Provider Name (Legal Business Name): MICHAEL KWAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2014
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803
US

IV. Provider business mailing address

601 E ROLLINS ST
ORLANDO FL
32803
US

V. Phone/Fax

Practice location:
  • Phone: 407-652-7040
  • Fax: 407-652-7041
Mailing address:
  • Phone: 321-207-0172
  • Fax: 321-207-0175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME144520
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA138880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: