Provider Demographics
NPI:1003001462
Name:WOLSKI, MICHAL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:J
Last Name:WOLSKI
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:800-994-0371
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-5285
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1124312085R0001X
GA725012085R0001X
TXP09422085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005967600Medicaid
FL355416OtherAVMED
FL14L48OtherBCBS
FLGF417QMedicare PIN
FLGF417TMedicare PIN
FLGF417XMedicare PIN
FLGF417YMedicare PIN
FL355416OtherAVMED
FL14L48OtherBCBS
FLGF417RMedicare PIN
FL005967600Medicaid
FLGF417VMedicare PIN
FLGF417SMedicare PIN