Basic Information
| Provider Information | |||||||||
| NPI: | 1912115817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICHALAK | ||||||||
| FirstName: | PETE | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5880 S HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GLOBE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855019447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284253261 | ||||||||
| FaxNumber: | 9284253859 | ||||||||
| Practice Location | |||||||||
| Address1: | 5880 S HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GLOBE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855019447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284253261 | ||||||||
| FaxNumber: | 9284253859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207P00000X | 1505 | AZ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 247503 | 05 | AZ | MEDICAID |