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NPI Code Detail

MEDICARE: MS. MICHELLE L MICHALAK ATC CSCS

MEDICARE: MS. MICHELLE L MICHALAK ATC CSCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12081S0010XSports Medicine (Physical Medicine & Rehabilitation) PhysicianIL

General Provider Information

NPI Number : 1073680286
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELLE L MICHALAK ATC CSCS
Provider Business Mailing Address
First Line : 13201 HEATHER MOSS DR
Second Line : #1502
City : ORLANDO
State : FL
Zip : 32837-5552
Country : US
Telephone Number : 630-750-3369
Fax Number :
Provider Business Practice Location Address
First Line : 5165 ADANSON ST
Second Line :
City : ORLANDO
State : FL
Zip : 32804-1331
Country : US
Telephone Number : 630-750-3369
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 08/07/2007

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