Provider Demographics
NPI:1437439684
Name:MICHAEL MENOLASCINO MD
Entity Type:Organization
Organization Name:MICHAEL MENOLASCINO MD
Other - Org Name:WILSON MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENOLASCINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-733-2855
Mailing Address - Street 1:PO BOX 1929
Mailing Address - Street 2:5235 HHR RANCH RD
Mailing Address - City:WILSON
Mailing Address - State:WY
Mailing Address - Zip Code:83014-1929
Mailing Address - Country:US
Mailing Address - Phone:307-733-2855
Mailing Address - Fax:307-734-0734
Practice Address - Street 1:5235 HHR RANCH RD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-1929
Practice Address - Country:US
Practice Address - Phone:307-733-2855
Practice Address - Fax:307-734-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4440A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty