Provider Demographics
NPI:1598185936
Name:MICHAELS, KRISTOF (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTOF
Middle Name:
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:KRZYSZTOF
Other - Middle Name:
Other - Last Name:MICHALCZUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:367 S. GULPH RD
Mailing Address - Street 2:ATT IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:775-356-9393
Mailing Address - Fax:775-356-5590
Practice Address - Street 1:5225 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3742
Practice Address - Country:US
Practice Address - Phone:941-708-8081
Practice Address - Fax:941-708-8085
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS14761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program