Provider Demographics
NPI:1366408528
Name:MICHALAK, ANDRE STANISLAW (M,D)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:STANISLAW
Last Name:MICHALAK
Suffix:
Gender:M
Credentials:M,D
Other - Prefix:
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Mailing Address - Street 1:1140 VARNUM ST NE
Mailing Address - Street 2:SUITE 208B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2151
Mailing Address - Country:US
Mailing Address - Phone:202-832-1532
Mailing Address - Fax:202-526-8516
Practice Address - Street 1:1140 VARNUM ST NE
Practice Address - Street 2:SUITE 208B
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2151
Practice Address - Country:US
Practice Address - Phone:202-832-1532
Practice Address - Fax:202-526-8516
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2010-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DC16523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
422980Medicare ID - Type Unspecified
D09594Medicare UPIN