Provider Demographics
NPI:1467757419
Name:SMA DEERLAKES, PC
Entity Type:Organization
Organization Name:SMA DEERLAKES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHISMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-767-5387
Mailing Address - Street 1:222 ALLEGHENY RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-1848
Mailing Address - Country:US
Mailing Address - Phone:412-767-5387
Mailing Address - Fax:412-828-6642
Practice Address - Street 1:222 ALLEGHENY RIVER BLVD
Practice Address - Street 2:
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-1848
Practice Address - Country:US
Practice Address - Phone:412-767-5387
Practice Address - Fax:412-828-6642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053615L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty