Healthcare Provider Details

I. General information

NPI: 1295690816
Provider Name (Legal Business Name): TRENT MIKALOWSKY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 CALUMET DR
SHEBOYGAN WI
53083-3839
US

IV. Provider business mailing address

N6356 KAPUR DR
SHEBOYGAN FALLS WI
53085-2355
US

V. Phone/Fax

Practice location:
  • Phone: 920-451-6908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number21038-130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: