Provider Demographics
NPI:1083719876
Name:DUJELA, MICHAEL DALE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DALE
Last Name:DUJELA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 VIEW POINT CT SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6357
Mailing Address - Country:US
Mailing Address - Phone:360-489-0927
Mailing Address - Fax:
Practice Address - Street 1:1900 COOKS HILL ROAD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9071
Practice Address - Country:US
Practice Address - Phone:360-736-2889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000717213ES0103X
WAWAPO00000717213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0166528OtherSTECK L&I
WA8377749Medicaid
WA9110DUOtherSTECK REGENCE
WA157969OtherL&I
WA8299265Medicaid
WA480033742OtherMEDICARE RR
WA2869DUOtherREGENCE RIDER
WA8299265Medicaid
WAGAB26162Medicare PIN
WA0166528OtherSTECK L&I
WA4409080001Medicare NSC