Provider Demographics
NPI:1699783647
Name:OPALAK, MICHAEL ERNEST (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERNEST
Last Name:OPALAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:203-336-3303
Mailing Address - Fax:203-336-5802
Practice Address - Street 1:340 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-336-3303
Practice Address - Fax:203-336-5802
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027114207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A28390Medicare UPIN