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General NPI Number Information
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NPI Number | 1104884790
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Entity Type | Individual
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Provider Name | MICHAEL H MICHALSKI MD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 5358 JACKSON DR SUITE 1
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City | LA MESA
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State | CA
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Zip | 91942-3040
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Country | US
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Telephone | 619-667-7072
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Fax | 619-667-7064
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Provider Business Mailing Address
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Address Line | PO BOX 2248
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City | LA MESA
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State | CA
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Zip | 91943
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Country | US
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Telephone | 619-667-7072
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Fax | 619-667-7064
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G86189
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | G86189
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License Number State | CA
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