Healthcare Provider Details

I. General information

NPI: 1356555098
Provider Name (Legal Business Name): MICHAEL A. MISHALANIE, DPM PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 SW 41ST ST
RENTON WA
98057-4926
US

IV. Provider business mailing address

433 SW 41ST ST
RENTON WA
98057-4926
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 Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL A MISHALANIE
Title or Position: PODIATRIST, OWNER
Credential: DPM
Phone: 425-226-5656