Provider Demographics
NPI:1881793305
Name:MICHALK, KATHLEEN R (DO)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:MICHALK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:560 S MAPLE ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1733
Mailing Address - Country:US
Mailing Address - Phone:952-442-2137
Mailing Address - Fax:952-442-5904
Practice Address - Street 1:560 S MAPLE ST
Practice Address - Street 2:SUITE 130
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1733
Practice Address - Country:US
Practice Address - Phone:952-442-2137
Practice Address - Fax:952-442-5904
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN52607207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43523800Medicaid
WI43523800Medicaid
H49305Medicare UPIN