Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 012965 | LA |
NPI | 1063411478 |
---|---|
Provider Name | Dr. Michael A Wilensky |
First Address | Metairie, LA 70002-6320 |
Second Address | Metairie, LA 70002-6320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 01/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00017097 | (05) | MS |
1184853 | (05) | LA |
B60678 | (02) | LA |