Provider Demographics
NPI:1487644720
Name:MLECKO, MICHAEL L
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:MLECKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 BROOKTREE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9260
Mailing Address - Country:US
Mailing Address - Phone:724-933-1420
Mailing Address - Fax:724-933-1439
Practice Address - Street 1:5500 BROOKTREE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9260
Practice Address - Country:US
Practice Address - Phone:724-933-1420
Practice Address - Fax:724-933-1439
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070118L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019227270001Medicaid
PA064792E81Medicare PIN
H74444Medicare UPIN