Provider Demographics
NPI:1356558464
Name:SLIMACK, MICHAEL JOSEF (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEF
Last Name:SLIMACK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:7401 104TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7845
Mailing Address - Country:US
Mailing Address - Phone:262-764-5595
Mailing Address - Fax:262-764-9314
Practice Address - Street 1:7401 104TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7845
Practice Address - Country:US
Practice Address - Phone:262-764-5595
Practice Address - Fax:262-764-9314
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2015-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH58000956207X00000X
WI51760207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI37580900Medicaid