Basic Information
| Provider Information | |||||||||
| NPI: | 1003801366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MICHALEK | ||||||||
| FirstName: | LEO | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 CENTER RD | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166770100 | ||||||||
| FaxNumber: | 7166770200 | ||||||||
| Practice Location | |||||||||
| Address1: | 561 RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | LACKAWANNA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142181319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168230141 | ||||||||
| FaxNumber: | 7168225468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 05/05/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 094920 | NY | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 00010118401 | 01 | UNIVERA | OTHER | 00601643 | 05 | NY | MEDICAID | 000505334001 | 01 | BCBS | OTHER | 1700291 | 01 | IHA | OTHER |