Provider Demographics
NPI:1417195603
Name:MICHALUK, BRIAN T (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:MICHALUK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1 HOSPITAL DR STE 306
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:964 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-7527
Practice Address - Country:US
Practice Address - Phone:570-742-2300
Practice Address - Fax:570-742-6276
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2022-06-09
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Provider Licenses
StateLicense IDTaxonomies
CA20A10786207Q00000X
PAOS019559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
EG268ZMedicare PIN