Individual
DR. MICHAEL N MOUSTAKAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 COTTAGE GROVE RD, SUITE B220, BLOOMFIELD, CT 06002-3080
(860) 769-9866
(860) 769-7300
Mailing address
35 JOLLEY DR, SUITE 203, BLOOMFIELD, CT 06002-3062
(860) 769-9866
(860) 769-7300
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
036735
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001367350
—
CT
Enumeration date
06/30/2005
Last updated
12/01/2016
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