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General NPI Number Information
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NPI Number | 1083719876
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Entity Type | Individual
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Provider Name | MICHAEL DALE DUJELA DPM
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 1900 COOKS HILL ROAD
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City | CENTRALIA
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State | WA
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Zip | 98531-9071
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Country | US
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Telephone | 360-736-2889
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Fax |
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Provider Business Mailing Address
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Address Line | 1669 VIEW POINT CT SW
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City | TUMWATER
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State | WA
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Zip | 98512-6357
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Country | US
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Telephone | 360-489-0927
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO00000717
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | WAPO00000717
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License Number State | WA
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