Provider Demographics
NPI:1982694501
Name:MISHALANIE, MICHAEL AZIZ (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:AZIZ
Last Name:MISHALANIE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 S 43RD ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5404
Mailing Address - Country:US
Mailing Address - Phone:425-226-5656
Mailing Address - Fax:425-271-1488
Practice Address - Street 1:401 S 43RD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5404
Practice Address - Country:US
Practice Address - Phone:425-226-5656
Practice Address - Fax:425-271-1488
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0017065213EP1101X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0017065OtherGRP 0056910 WORKERS COMP
WA029382001OtherCIGNA MEDICARE
WA911337710OtherPREMERA
WAMI2246OtherGRP 5229 REGENCE
192061900OtherUS DEPT OF LABOR
WA911337710OtherPREMERA
T01730Medicare UPIN