1548773849 NPI number — LESLIE K MICHALSKI LMT

Table of content: LESLIE K MICHALSKI LMT (NPI 1548773849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548773849 NPI number — LESLIE K MICHALSKI LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHALSKI
Provider First Name:
LESLIE
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548773849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1036 W 22ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99503-1738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-562-2273
Provider Business Mailing Address Fax Number:
800-782-4191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 W TUDOR RD STE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-562-2273
Provider Business Practice Location Address Fax Number:
800-782-4191
Provider Enumeration Date:
11/08/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  125764 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 125764 . This is a "LMT LICENSE" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".