MEDICARE: DR. MICHAEL L WOLAK PH.D., M.D.

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
1	207T00000X	Neurological Surgery Physician	10500	SD
2	207T00000X	Neurological Surgery Physician	4301091375	MI
3	207T00000X	Neurological Surgery Physician	2019-00956	NC
4	207T00000X	Neurological Surgery Physician	ME117533	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1235323981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL L WOLAK PH.D., M.D.

Provider Business Mailing Address
First Line	:	2440 HOOKS ST
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-3514
Country	:	US
Telephone Number	:	321-841-7550
Fax Number	:	321-841-8185

Provider Business Practice Location Address
First Line	:	2440 HOOKS ST
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-3514
Country	:	US
Telephone Number	:	321-841-7550
Fax Number	:	321-841-8185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	03/30/2022

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