Provider Demographics
NPI:1023395647
Name:TODA, MICHITA (EDM, ATC, CES)
Entity Type:Individual
Prefix:MR
First Name:MICHITA
Middle Name:
Last Name:TODA
Suffix:
Gender:M
Credentials:EDM, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2051
Mailing Address - Country:US
Mailing Address - Phone:608-225-6826
Mailing Address - Fax:608-265-4736
Practice Address - Street 1:1440 MONROE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2051
Practice Address - Country:US
Practice Address - Phone:608-225-6826
Practice Address - Fax:608-265-4736
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1612-39174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist