Provider Demographics
NPI:1093824591
Name:MICHALAK, RONALD E (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:MICHALAK
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 1:458 OLD STREET RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1265
Mailing Address - Country:US
Mailing Address - Phone:603-924-2144
Mailing Address - Fax:603-924-3993
Practice Address - Street 1:458 OLD STREET RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1265
Practice Address - Country:US
Practice Address - Phone:603-924-2144
Practice Address - Fax:603-924-3993
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11969174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH01Y005045NH02OtherANTHEM BCBS MCH
NH30203621Medicaid
NH01Y005045NH03OtherANTHEM BCBS MOA
NH01Y005045NH02OtherANTHEM BCBS MCH
NHH90537Medicare UPIN