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NPI Code Detail

MEDICARE: DR. MICHAEL C MISJA PH.D.

MEDICARE:  DR. MICHAEL C MISJA  PH.D.
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
1103T00000XPsychologist4767OH

General Provider Information

NPI Number : 1104869916
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL C MISJA PH.D.
Provider Business Mailing Address
First Line : 6929 W. 130TH ST.
Second Line : SUITE 500
City : PARMA HTS
State : OH
Zip : 44130-7878
Country : US
Telephone Number : 440-842-6867
Fax Number : 440-842-8914
Provider Business Practice Location Address
First Line : 6929 W. 130TH ST.
Second Line : SUITE 500
City : PARMA HTS
State : OH
Zip : 44130-7878
Country : US
Telephone Number : 440-842-6867
Fax Number : 440-842-8914
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 07/08/2007

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Directions to “ DR. MICHAEL C MISJA PH.D.” Practice Location

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