Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | IL | |
Y | 213ES0000X | Sports Medicine | IL |
NPI | 1073680286 |
---|---|
Provider Name | Ms. Michelle L Michalak |
First Address | Orlando, FL 32837-5552 |
Second Address | Orlando, FL 32804-1331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 07/08/2007 |