Basic Information
| Provider Information | |||||||||
| NPI: | 1235323981 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLAK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D., M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2440 HOOKS ST | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347113514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218417550 | ||||||||
| FaxNumber: | 3218418185 | ||||||||
| Practice Location | |||||||||
| Address1: | 2440 HOOKS ST | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347113514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218417550 | ||||||||
| FaxNumber: | 3218418185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2007 | ||||||||
| LastUpdateDate: | 03/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 10500 | SD | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 4301091375 | MI | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 2019-00956 | NC | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | ME117533 | FL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.