Individual
DR. MITCHELL L WIATRAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
310 N L ROGERS WELLS BLVD, GLASGOW, KY 42141-1300
(270) 659-5965
(270) 659-5856
Mailing address
310 N L ROGERS WELLS BLVD, GLASGOW, KY 42141-1300
(270) 659-5965
(270) 659-5856
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
42456
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100117860
—
KY
Enumeration date
10/05/2005
Last updated
03/07/2023
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