Provider Demographics
NPI:1003801366
Name:MICHALEK, LEO MICHAEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:MICHAEL
Last Name:MICHALEK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224
Mailing Address - Country:US
Mailing Address - Phone:716-677-0100
Mailing Address - Fax:716-677-0200
Practice Address - Street 1:561 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1319
Practice Address - Country:US
Practice Address - Phone:716-823-0141
Practice Address - Fax:716-822-5468
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094920208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
00010118401OtherUNIVERA
NY00601643Medicaid
000505334001OtherBCBS
1700291OtherIHA
1700291OtherIHA
NY00601643Medicaid