Provider Demographics
NPI:1467449363
Name:WILCHINSKI, MICHAEL T (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:WILCHINSKI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN213588L163W00000X
PA033275367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0763743000OtherIBC
PA33530OtherGEISINGER
PA0616740OtherHIGHMARK
PA9539429OtherAETNA
PA03226001OtherCAPITAL ADVANTAGE
PA1019821470003Medicaid
PA11754816OtherCAQH
PA0616740OtherFIRST PRIORITY
PA1579980OtherGATEWAY
PA0616740OtherKHP CENTRAL
PA616740QCYMedicare PIN
PA430070477Medicare PIN
PA0763743000OtherIBC
PA0616740OtherHIGHMARK