Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | G86189 | CA |
N | 207RI0011X | Interventional Cardiology | G86189 | CA |
NPI | 1104884790 |
---|---|
Provider Name | Michael H Michalski |
First Address | La Mesa, CA 91943 |
Second Address | La Mesa, CA 91942-3040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 30/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G861890 | (05) | CA |
H60946 | (02) |