Provider Demographics
NPI:1417428269
Name:MIHALOVIC, AUSTIN ROBERT
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:ROBERT
Last Name:MIHALOVIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5021 SUNSET VISTA RD
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-9105
Mailing Address - Country:US
Mailing Address - Phone:608-792-5329
Mailing Address - Fax:
Practice Address - Street 1:N5021 SUNSET VISTA RD
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-9105
Practice Address - Country:US
Practice Address - Phone:608-792-5329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer