Healthcare Provider Details

I. General information

NPI: 1083719876
Provider Name (Legal Business Name): MICHAEL DALE DUJELA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COOKS HILL ROAD
CENTRALIA WA
98531-9071
US

IV. Provider business mailing address

1669 VIEW POINT CT SW
TUMWATER WA
98512-6357
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-2889
  • Fax:
Mailing address:
  • Phone: 360-489-0927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO00000717
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberWAPO00000717
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: