Provider Demographics
NPI:1124119185
Name:ATAY, SONGUL (MD)
Entity type:Individual
Prefix:DR
First Name:SONGUL
Middle Name:
Last Name:ATAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S MAPLE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3739
Mailing Address - Country:US
Mailing Address - Phone:641-469-4204
Mailing Address - Fax:641-469-4208
Practice Address - Street 1:300 S MAPLE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3739
Practice Address - Country:US
Practice Address - Phone:641-469-4204
Practice Address - Fax:641-469-4208
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37410207RG0100X
CAA64994207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G64567Medicare UPIN