Provider Demographics
NPI:1730492422
Name:ANDRE S MICHALAK MD PC
Entity Type:Organization
Organization Name:ANDRE S MICHALAK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MICHALAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-832-1532
Mailing Address - Street 1:1140 VARNUM STREET NE
Mailing Address - Street 2:SUITE 208B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2153
Mailing Address - Country:US
Mailing Address - Phone:202-832-1532
Mailing Address - Fax:
Practice Address - Street 1:1140 VARNUM ST NE
Practice Address - Street 2:SUITE 208B
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2151
Practice Address - Country:US
Practice Address - Phone:202-832-1532
Practice Address - Fax:202-526-8516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD16523261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC422980Medicare UPIN