Provider Demographics
NPI:1518151224
Name:J. MICHAELSON, JR. M.D. FACOG, P.S.
Entity Type:Organization
Organization Name:J. MICHAELSON, JR. M.D. FACOG, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAELSON, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-697-2453
Mailing Address - Street 1:1703 S MERIDIAN STE 301
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7590
Mailing Address - Country:US
Mailing Address - Phone:253-697-2453
Mailing Address - Fax:
Practice Address - Street 1:1703 S MERIDIAN STE 301
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7590
Practice Address - Country:US
Practice Address - Phone:253-697-2453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031843207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1088277Medicaid
WA1088277Medicaid
WA115000255Medicare PIN