Basic Information
| Provider Information | |||||||||
| NPI: | 1245218056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEMOTUK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 W CENTRAL ENTRANCE # 160 | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558113433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187223700 | ||||||||
| FaxNumber: | 2187228705 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 E 34TH ST | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557462341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182624881 | ||||||||
| FaxNumber: | 2183626699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2006 | ||||||||
| LastUpdateDate: | 06/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 41528 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | 41528 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 41528 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0203X | 41528 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0204X | 41528 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | 41528 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0202X | 41528 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 34387800 | 05 | WI | MEDICAID | 186318500 | 05 | MN | MEDICAID |