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General NPI Number Information
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NPI Number | 1811209406
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Entity Type | Individual
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Provider Name | MICHAEL PIETAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 200 TRENT DR DUKE CLINIC 1L
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City | DURHAM
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State | NC
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Zip | 27710-3037
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Country | US
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Telephone | 919-684-5870
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Fax | 919-684-0131
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Provider Business Mailing Address
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Address Line | 2616 ERWIN RD APT 2228
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City | DURHAM
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State | NC
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Zip | 27705-3843
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Country | US
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Telephone | 734-233-5267
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301097267
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License Number State | MI
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