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General NPI Number Information
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NPI Number | 1518151224
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Entity Type | Organization
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Legal Business Name | J. MICHAELSON, JR. M.D. FACOG, P.S.
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 1703 S MERIDIAN STE 301
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City | PUYALLUP
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State | WA
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Zip | 98371-7590
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Country | US
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Telephone | 253-697-2453
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Fax |
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Provider Business Mailing Address
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Address Line | 1703 S MERIDIAN STE 301
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City | PUYALLUP
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State | WA
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Zip | 98371-7590
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Country | US
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Telephone | 253-697-2453
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIUS MICHAELSON, JR.
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Credential | M.D.
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Telephone | 253-697-2453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD00031843
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License Number State | WA
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