Healthcare Provider Details

I. General information

NPI: 1982694501
Provider Name (Legal Business Name): MICHAEL AZIZ MISHALANIE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S 43RD ST SUITE 110
RENTON WA
98055-5404
US

IV. Provider business mailing address

401 S 43RD ST SUITE 110
RENTON WA
98055-5404
US

V. Phone/Fax

Practice location:
  • Phone: 425-226-5656
  • Fax: 425-271-1488
Mailing address:
  • Phone: 425-226-5656
  • Fax: 425-271-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number0017065
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number0017065
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0017065
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: