Provider Demographics
NPI:1003863416
Name:VICTOR R. MICHALAK, MD
Entity Type:Organization
Organization Name:VICTOR R. MICHALAK, MD
Other - Org Name:COSMETIC SURGERY & DERMATOLOGY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:ROMAN
Authorized Official - Last Name:MICHALAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-391-2500
Mailing Address - Street 1:295 NE GILMAN BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2906
Mailing Address - Country:US
Mailing Address - Phone:425-391-2500
Mailing Address - Fax:425-391-6464
Practice Address - Street 1:295 NE GILMAN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2906
Practice Address - Country:US
Practice Address - Phone:425-391-2500
Practice Address - Fax:425-391-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7129554Medicaid
WA7129554Medicaid