Provider Demographics
NPI:1720335581
Name:DAVID W MICHALAK MD PA
Entity Type:Organization
Organization Name:DAVID W MICHALAK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MICHALAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-367-1720
Mailing Address - Street 1:4840 W PANTHER CREEK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3527
Mailing Address - Country:US
Mailing Address - Phone:281-367-1720
Mailing Address - Fax:281-681-3311
Practice Address - Street 1:4840 W PANTHER CREEK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3527
Practice Address - Country:US
Practice Address - Phone:281-367-1720
Practice Address - Fax:281-681-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-11
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty