NPIMap

Organization Active NPI

Victor R. Michalak, MD

  • Dermatology Physician
  • Issaquah, WA
National Provider Identifier
1003863416
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
VICTOR R. MICHALAK, MD
Practice address
295 NE Gilman Blvd
Suite 101
Issaquah, WA 98027-2906
Phone
(425) 391-2500
Fax
(425) 391-6464
NPI assigned
May 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Victor Roman Michalak, MDNPI 1922050616
Title
Owner/Physician
Phone
(425) 391-2500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

295 NE Gilman Blvd
Suite 101
Issaquah, WA 98027-2906

Mailing address

295 NE Gilman Blvd
Suite 101
Issaquah, WA 98027-2906
Phone (425) 391-2500

Other identifiers 1

IdentifierTypeStateIssuer
7129554MedicaidWA

Other names 1

  • Cosmetic Surgery & Dermatology, Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040109000056 WA Part B Supplier - Clinic/Group Practice 8022918994 Receives reassigned benefits from 5 practitioners
Practice locations: Issaquah, WA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

295 NE Gilman Blvd
Ste 101
Issaquah, WA 98027
Phone (425) 391-2500

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1003863416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 NE GILMAN BLVD",
            "address_2": "SUITE 101",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272906",
            "telephone_number": "425-391-2500",
            "fax_number": "425-391-6464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 NE GILMAN BLVD",
            "address_2": "SUITE 101",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272906",
            "telephone_number": "425-391-2500",
            "fax_number": "425-391-6464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTOR R. MICHALAK, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-30",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "MICHALAK",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "ROMAN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "425-391-2500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7129554",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cosmetic Surgery & Dermatology, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.