Active NPI
Ty Kristofer Michalowski, ATC
- Athletic Trainer
- Waukesha, WI
National Provider Identifier
1265146716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 3044-39
- Practice address
- 114 Hinman Ave
Waukesha, WI 53186-6003 - Phone
- (970) 409-8321
- NPI assigned
- Jan 10, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 3044-39 | WI | Primary |
Addresses
Primary practice location
114 Hinman Ave
Waukesha, WI 53186-6003
Mailing address
114 Hinman Ave
Waukesha, WI 53186-6003
Phone (970) 409-8321
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3044-39 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1673308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673308800000",
"number": "1265146716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 HINMAN AVE",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531866003",
"telephone_number": "970-409-8321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 HINMAN AVE",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531866003",
"telephone_number": "970-409-8321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICHALOWSKI",
"first_name": "TY",
"middle_name": "KRISTOFER",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-10",
"last_updated": "2023-01-10",
"certification_date": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "3044-39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukesha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.