Provider Demographics
NPI:1306165162
Name:MICHAEL A WASYLIK MD PA
Entity type:Organization
Organization Name:MICHAEL A WASYLIK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPAEDIC SURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WASYLIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-877-9413
Mailing Address - Street 1:2919 W SWANN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4038
Mailing Address - Country:US
Mailing Address - Phone:813-877-9413
Mailing Address - Fax:813-876-0980
Practice Address - Street 1:2919 W SWANN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4038
Practice Address - Country:US
Practice Address - Phone:813-877-9413
Practice Address - Fax:813-876-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0023025207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054037400Medicaid
FL0441160001Medicare NSC
FLDB562AMedicare PIN
FL054037400Medicaid