Provider Demographics
NPI:1598760225
Name:TOMCZAK, MICHELE JOAN (DO)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:JOAN
Last Name:TOMCZAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-2316
Mailing Address - Country:US
Mailing Address - Phone:814-877-5800
Mailing Address - Fax:814-877-5809
Practice Address - Street 1:4500 PINE AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2316
Practice Address - Country:US
Practice Address - Phone:814-877-5800
Practice Address - Fax:814-877-5809
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008255L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA205111OtherUPMC
PA710448OtherBLUE SHIELD
PA3119425OtherAETNA
NY02149306OtherNY MEDICAL ASSISTANCE
NY00026080801OtherUNIVERA
PA080187225OtherRR MEDICARE
PAP000436OtherGATEWAY
PA0015182950004Medicaid
PA70078OtherUNISON
OH2220402OtherOH MEDICAL ASSISTANCE
PA710448E7CMedicare PIN
PA70078OtherUNISON