MEDICARE: PETER P MICHALAK MD

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
1	207Q00000X	Family Medicine Physician	64431	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	64431	OTHER	AZ	AZ LICENSE

General Provider Information

NPI Number	:	1104321777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER P MICHALAK MD

Provider Business Mailing Address
First Line	:	4801 E BROADWAY BLVD STE 251
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2700
Country	:	US
Telephone Number	:	520-327-0460
Fax Number	:	520-795-0225

Provider Business Practice Location Address
First Line	:	1631 W INA RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1985
Country	:	US
Telephone Number	:	520-585-5738
Fax Number	:	520-585-5843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	06/18/2026

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Directions to “ PETER P MICHALAK MD” Practice Location

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