Basic Information
Provider Information
NPI: 1003001462
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOLSKI
FirstName: MICHAL
MiddleName: J.
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 844658
Address2:  
City: DALLAS
State: TX
PostalCode: 752844658
CountryCode: US
TelephoneNumber: (800) 994-0371
FaxNumber:  
Practice Location
Address1: 2401 S 31ST ST
Address2:  
City: TEMPLE
State: TX
PostalCode: 765085285
CountryCode: US
TelephoneNumber: 2547242111
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/10/2007
LastUpdateDate: 07/12/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001XP0942TXY Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
2085R0001X72501GAN Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
2085R0001XME112431FLN Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

ID Information
IDTypeStateIssuerDescription
35541601FLAVMEDOTHER
00596760005FL MEDICAID
14L4801FLBCBSOTHER


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