Healthcare Provider Details

I. General information

NPI: 1023004082
Provider Name (Legal Business Name): JOHN ALEXANDER MICHALSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WHEELING AVE FL 1
GLEN DALE WV
26038-1660
US

IV. Provider business mailing address

90 N 4TH ST MICHALSKI ORTHOPEDIC CENTER, LLC
MARTINS FERRY OH
43935-1648
US

V. Phone/Fax

Practice location:
  • Phone: 304-221-4520
  • Fax:
Mailing address:
  • Phone: 740-633-4790
  • Fax: 740-633-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.078449
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number78449
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20227
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: