Provider Demographics
NPI:1922050616
Name:MICHALAK, VICTOR ROMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ROMAN
Last Name:MICHALAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 NE GILMAN BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2906
Mailing Address - Country:US
Mailing Address - Phone:425-391-2500
Mailing Address - Fax:425-391-6464
Practice Address - Street 1:295 NE GILMAN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2906
Practice Address - Country:US
Practice Address - Phone:425-391-2500
Practice Address - Fax:425-391-6464
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024607174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1063817Medicaid
WAD05352Medicare UPIN
WA1063817Medicaid