Individual
ISTVAN DAVID WOLLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 SOUTHCREST CIR, SUITE 212, SOUTHAVEN, MS 38671-6726
(662) 349-0488
(662) 349-5974
Mailing address
2120 EXETER RD, STE 250, GERMANTOWN, TN 38138-3931
(901) 767-5864
(901) 767-6591
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
19168
MS
207RP1001X
Pulmonary Disease Physician
Primary
19168
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19168
LICENSE NUMBER
MS
Enumeration date
06/10/2006
Last updated
01/24/2022
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