Provider Demographics
NPI:1467632158
Name:MICHAEL H. MICHALSKI, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL H. MICHALSKI, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:MICHALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-667-7072
Mailing Address - Street 1:PO BOX 2248
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91943-2248
Mailing Address - Country:US
Mailing Address - Phone:619-667-7072
Mailing Address - Fax:
Practice Address - Street 1:5358 JACKSON DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3040
Practice Address - Country:US
Practice Address - Phone:619-667-7072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86189207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G861890Medicaid
CAW16851Medicare PIN