Basic Information
| Provider Information | |||||||||
| NPI: | 1144439548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TELISAK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 10TH ST SE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524032414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193992022 | ||||||||
| FaxNumber: | 3193992014 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 10TH ST SE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524032414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193992022 | ||||||||
| FaxNumber: | 3193992014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 03/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | R7303 | IA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 53225 | WI | N | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.