Basic Information
| Provider Information | |||||||||
| NPI: | 1376599324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CIHLA | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 YORK ST | ||||||||
| Address2: | |||||||||
| City: | MANITOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542204630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9206639008 | ||||||||
| FaxNumber: | 9206841439 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 SCHEURING RD | ||||||||
| Address2: | |||||||||
| City: | DE PERE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541151067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9209640229 | ||||||||
| FaxNumber: | 9209640248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 01083642A | IN | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 65970 | MN | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 32428 | WI | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | P00609404 | 01 | WI | RAILROAD MEDICARE | OTHER | 32428020 | 01 | WI | STATE LICENSE | OTHER | BC2940206 | 01 | WI | DEA | OTHER | 32059700 | 05 | WI | MEDICAID |