Provider Demographics
NPI:1336261106
Name:MICHNOWSKA, MARIA Z (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:Z
Last Name:MICHNOWSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ANREY CT
Mailing Address - Street 2:
Mailing Address - City:MURPHYS
Mailing Address - State:CA
Mailing Address - Zip Code:95247-9385
Mailing Address - Country:US
Mailing Address - Phone:209-754-4564
Mailing Address - Fax:
Practice Address - Street 1:704 MOUNTAIN RANCH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-0000
Practice Address - Country:US
Practice Address - Phone:209-754-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA73232EMedicare ID - Type Unspecified
CAWA73232FMedicare ID - Type Unspecified
CAWA73232CMedicare ID - Type Unspecified
CAWA73232GMedicare ID - Type Unspecified
H53407Medicare UPIN
CAWA73232DMedicare ID - Type Unspecified