Provider Demographics
NPI:1649663782
Name:DEAL, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 COUNTY ROAD HH
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:WI
Mailing Address - Zip Code:53507-9728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5701 COUNTY ROAD HH
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:WI
Practice Address - Zip Code:53507-9728
Practice Address - Country:US
Practice Address - Phone:608-438-9255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer