Individual
DR. MICHAEL THOMAS FLISAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3500 FRANCISCAN WAY STE 400, MICHIGAN CITY, IN 46360-0021
(219) 878-8200
(219) 877-8331
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036118827
IL
207RC0000X
Cardiovascular Disease Physician
55811
WI
207RI0011X
Interventional Cardiology Physician
Primary
02005248
IN
207RI0011X
Interventional Cardiology Physician
036118827
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621208
BLUE CROSS BLUE SHIELD GROUP PROVIDER
IL
01
—
1508810086
GROUP NPI
—
05
—
300009476
—
IN
01
—
P01078187
RR MEDICARE
IL
Enumeration date
08/05/2008
Last updated
03/05/2019
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