Provider Demographics
NPI:1073550182
Name:MICHALAK, MICHAEL VINCENT (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:VINCENT
Last Name:MICHALAK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-754-3000
Mailing Address - Fax:989-755-1365
Practice Address - Street 1:1015 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2556
Practice Address - Country:US
Practice Address - Phone:989-754-3000
Practice Address - Fax:989-755-1365
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002176363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0560110P01Medicare PIN
MI0N88320002Medicare PIN
R66397Medicare UPIN