Provider Demographics
NPI:1164565776
Name:MICHALUK, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MICHALUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 HIGH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3100
Practice Address - Country:US
Practice Address - Phone:570-321-2619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016539208100000X, 2081P0004X
MDP20637208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1178590OtherGATEWAY HEALTH
PA50118168OtherCAPITAL BC
PA003005946OtherBLUE SHIELD
PA102837801-0001Medicaid
PAP01222886OtherRR MEDICARE
PA30160898OtherAMERIHEALTH NORTHEAST
PA25-1645055OtherHUMANA-CHOICE CARE
PA4705221OtherCIGNA
PA4817102OtherAETNA
PA831497OtherPREMIER BLUE/FPH
PA1164565776OtherUNITED HEALTH CARE
PA1164565776OtherGEISINGER HEALTH PLAN
PA25-1645055OtherCOVENTRY/HEALTH AMERICA
PA4705221OtherCIGNA