Provider Demographics
NPI:1588827729
Name:NUNAG, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NUNAG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 S LAKE DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-3171
Mailing Address - Country:US
Mailing Address - Phone:414-489-9050
Mailing Address - Fax:414-489-4015
Practice Address - Street 1:5900 S LAKE DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-3171
Practice Address - Country:US
Practice Address - Phone:414-489-9050
Practice Address - Fax:414-489-4015
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125055375OtherSTATE LICENSE