Provider Demographics
NPI:1598985350
Name:PRODESSE, INC.
Entity Type:Organization
Organization Name:PRODESSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHALOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-792-5046
Mailing Address - Street 1:W229N1870 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1302
Mailing Address - Country:US
Mailing Address - Phone:262-446-0700
Mailing Address - Fax:262-446-0600
Practice Address - Street 1:W229N1870 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1302
Practice Address - Country:US
Practice Address - Phone:262-446-0700
Practice Address - Fax:262-446-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52D0906595291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory