Provider Demographics
NPI:1689872962
Name:IGNATOWSKI, MICHAEL J (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:IGNATOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:627 S EDWIN C MOSES BLVD
Mailing Address - Street 2:WRIGHT STATE PSYCHIATRY
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45408-1461
Mailing Address - Country:US
Mailing Address - Phone:937-223-8840
Mailing Address - Fax:
Practice Address - Street 1:627 S EDWIN C MOSES BLVD
Practice Address - Street 2:WRIGHT STATE PSYCHIATRY
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1461
Practice Address - Country:US
Practice Address - Phone:937-223-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.0021862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHIG42269681Medicare PIN