Provider Demographics
NPI:1790876506
Name:DR. MICHAEL S. ZALESKI
Entity Type:Organization
Organization Name:DR. MICHAEL S. ZALESKI
Other - Org Name:TOTAL FOOT CARE CLINIC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AUTHORIZED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:ZALESKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:601-268-0400
Mailing Address - Street 1:PO BOX 16235
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-6235
Mailing Address - Country:US
Mailing Address - Phone:601-268-0400
Mailing Address - Fax:601-264-3150
Practice Address - Street 1:34 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1318
Practice Address - Country:US
Practice Address - Phone:601-268-0400
Practice Address - Fax:601-264-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80131213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015719Medicaid
MS480031794OtherRAILROAD MEDICARE
MS08574705OtherMS MEDICAID DME
MS4154340001Medicare NSC
MS08574705OtherMS MEDICAID DME