Provider Demographics
NPI:1184783326
Name:MICHALSKI, NICHOLAS JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JOSEPH
Last Name:MICHALSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11644 W 75TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1372
Mailing Address - Country:US
Mailing Address - Phone:913-962-4004
Mailing Address - Fax:913-962-6817
Practice Address - Street 1:11644 W 75TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66214-1372
Practice Address - Country:US
Practice Address - Phone:913-962-4004
Practice Address - Fax:913-962-6817
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KSKS19239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSC50464Medicare UPIN