Provider Demographics
NPI:1033193347
Name:FLEAK, MICHELE DAWN (MD,)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:DAWN
Last Name:FLEAK
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 UNION AVE
Mailing Address - Street 2:SUITE 187
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-3004
Mailing Address - Country:US
Mailing Address - Phone:330-343-4411
Mailing Address - Fax:330-364-1114
Practice Address - Street 1:515 UNION AVE
Practice Address - Street 2:SUITE 187
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-3004
Practice Address - Country:US
Practice Address - Phone:330-343-4411
Practice Address - Fax:330-364-1114
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2323239Medicaid
OHFL4082452Medicare ID - Type Unspecified
OH2323239Medicaid