Provider Demographics
NPI:1144286360
Name:WARTAK, ANDRZEJ (MD)
Entity type:Individual
Prefix:
First Name:ANDRZEJ
Middle Name:
Last Name:WARTAK
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 1:850 EMERGENCY DR
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-9357
Mailing Address - Country:US
Mailing Address - Phone:662-494-1870
Mailing Address - Fax:662-494-0002
Practice Address - Street 1:850 EMERGENCY DR
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-9357
Practice Address - Country:US
Practice Address - Phone:662-494-1870
Practice Address - Fax:662-494-0002
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114997Medicaid
MS00114997Medicaid
MS110001078Medicare ID - Type Unspecified