Provider Demographics
NPI:1811094972
Name:OLACIREGUI, MICHAEL G (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:OLACIREGUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11430
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-0430
Mailing Address - Country:US
Mailing Address - Phone:414-962-9070
Mailing Address - Fax:414-962-9050
Practice Address - Street 1:573 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1141
Practice Address - Country:US
Practice Address - Phone:414-385-9801
Practice Address - Fax:414-385-9803
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI42851-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34071200Medicaid
WI00011824Medicare ID - Type Unspecified
WI34071200Medicaid