Provider Demographics
NPI:1679512404
Name:POPIK, MICHAEL G (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:POPIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:12 PARTRIDGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473-1400
Mailing Address - Country:US
Mailing Address - Phone:978-466-2685
Mailing Address - Fax:978-466-2693
Practice Address - Street 1:60 HOSPITAL RD
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2205
Practice Address - Country:US
Practice Address - Phone:978-466-2685
Practice Address - Fax:978-466-2685
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA0524542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6198341Medicaid
B76712Medicare UPIN
MAJ04750Medicare ID - Type Unspecified