Individual
DR. MICHAEL W. ITAGAKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-4848
(920) 288-4956
Mailing address
1035 KEPLER DR, GREEN BAY, WI 54311-8320
(920) 490-9046
(920) 405-8005
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
81016-20
WI
2085R0202X
Diagnostic Radiology Physician
A99197
CA
2085R0202X
Diagnostic Radiology Physician
MD60125332
WA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
81016
WI
2085R0204X
Vascular & Interventional Radiology Physician
MD60125332
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100212024
—
WI
05
—
2023112
—
WA
01
—
305309
LNI PROVIDER ID
WA
01
—
314444
LNI PROVIDER ID
WA
05
—
685050
—
HI
Enumeration date
10/15/2008
Last updated
08/06/2025
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