Provider Demographics
NPI:1104884790
Name:MICHALSKI, MICHAEL H (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:MICHALSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2248
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91943
Mailing Address - Country:US
Mailing Address - Phone:619-667-7072
Mailing Address - Fax:619-667-7064
Practice Address - Street 1:5358 JACKSON DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3040
Practice Address - Country:US
Practice Address - Phone:619-667-7072
Practice Address - Fax:619-667-7064
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86189207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G861890Medicaid
CA00G861890Medicaid
CAWG86189BMedicare PIN