Michelle Olga Mironovich

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

8641 Issued in WI

Practice address

1110 Kepler Dr
Green Bay, WI 54311-8306

Phone

(920) 288-5555

Fax

(920) 288-5550

NPI assigned

May 6, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baycare Clinic LLPGroup PAC ID 4385554328, 197 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Aurora Baycare Medical Ctr Hospital, Green Bay, WI, CCN 520193

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmironovich493457@ewd.direct.hshs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Baycare Clinic LLP

  • Emergency Medicine Physician
  • Green Bay, WI
  • NPI 1588609648
  Medicare reassignment Care Compare group NPD
• Baycare Clinic LLP

  • Durable Medical Equipment & Medical Supplies
  • Manitowoc, WI
  • NPI 1134490758
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baycare Aurora, LLC

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1255387726
  Care Compare affiliation

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

{
    "created_epoch": "1714953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778112000000",
    "number": "1881441962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 KEPLER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118320",
            "telephone_number": "920-490-9046",
            "fax_number": "920-405-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 KEPLER DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543118306",
            "telephone_number": "920-288-5555",
            "fax_number": "920-288-5550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2502 S Ashland Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543045252",
            "country_code": "US",
            "telephone_number": "651-635-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRONOVICH",
        "first_name": "MICHELLE",
        "middle_name": "OLGA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-06",
        "last_updated": "2026-05-07",
        "certification_date": "2026-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "8641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Milwaukee Vamc
• Milwaukee Vamc
• Mindright Behavior & Consulting
• Michelle Lyn Minikel, MD
• Lori Minten-Verheyden, NP
• Lois L Mischler, MS, LCSW
• Michael M Miskella, D.D.S.
• Heather L Miskulin, PHARMD
• Timm Scott Missbach, MD
• Kaylee Marie Mitch, OT

• Physician Assistant in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.