Provider Demographics
NPI:1922087220
Name:MICHALSKI, WILLARD JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WILLARD
Middle Name:JAMES
Last Name:MICHALSKI
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 1:112 BEECH STREET
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-625-1589
Mailing Address - Fax:
Practice Address - Street 1:112 BEECH STREET
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-625-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22210207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040008067OtherRR MEDICARE
MN115547OtherUCARE
MN1001399OtherMEDICA
MN555882400Medicaid
MN767278OtherAMERICAS PPO
MNHP25854OtherHEALTH PARTNERS
MN41461MIOtherBCBS
IA928655OtherMEDICAID
MNNA2951023845OtherPREFERRED ONE
410849339 56001 C047OtherCHAMPUS
IA928655OtherMEDICAID
MN555882400Medicaid