Healthcare Provider Details

I. General information

NPI: 1053462283
Provider Name (Legal Business Name): SCOTT THOMAS MICHALSKI M.S., C.G.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 N CAPITOL AVE SUITE 468
INDIANAPOLIS IN
46202-1261
US

IV. Provider business mailing address

4918 W 15TH ST
SPEEDWAY IN
46224-6506
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-0663
  • Fax: 317-962-0660
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: