Provider Demographics
NPI:1760568760
Name:REZNICEK, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:REZNICEK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1717 S RUSTLE RD
Mailing Address - Street 2:SUITE 212A
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-2065
Mailing Address - Country:US
Mailing Address - Phone:509-315-4142
Mailing Address - Fax:509-242-0797
Practice Address - Street 1:1717 S RUSTLE RD
Practice Address - Street 2:SUITE 212A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-2065
Practice Address - Country:US
Practice Address - Phone:509-315-4142
Practice Address - Fax:509-242-0797
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2023-05-19
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Provider Licenses
StateLicense IDTaxonomies
WAMD000369532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF70165Medicare UPIN