Healthcare Provider Details

I. General information

NPI: 1972540110
Provider Name (Legal Business Name): MICHAEL G MURNIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WATER STREET
BLUE HILL ME
04614
US

IV. Provider business mailing address

57 WATER STREET
BLUE HILL ME
04614
US

V. Phone/Fax

Practice location:
  • Phone: 207-374-2311
  • Fax: 207-374-3991
Mailing address:
  • Phone: 207-374-2311
  • Fax: 207-374-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD17154
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: