Provider Demographics
NPI:1215912928
Name:ZALESKI, MICHAEL SEAN (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SEAN
Last Name:ZALESKI
Suffix:
Gender:M
Credentials:DPM
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 16235
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-6235
Mailing Address - Country:US
Mailing Address - Phone:601-268-0400
Mailing Address - Fax:601-296-3251
Practice Address - Street 1:34 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1318
Practice Address - Country:US
Practice Address - Phone:601-268-0400
Practice Address - Fax:601-296-3251
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80131213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123480Medicaid
480031794OtherRAILROAD MEDICARE
MS00123480Medicaid