Provider Demographics
NPI:1437793478
Name:SOKOLSKI, MICHAEL JOHN PAUL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN PAUL
Last Name:SOKOLSKI
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:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53170-0424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 W DEPOT ST
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:WI
Practice Address - Zip Code:53170-1531
Practice Address - Country:US
Practice Address - Phone:262-818-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-02
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer