Provider Demographics
NPI:1639361975
Name:OLEKSAK, MICHELE ANN (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANN
Last Name:OLEKSAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-0579
Mailing Address - Country:US
Mailing Address - Phone:724-543-8164
Mailing Address - Fax:724-543-8616
Practice Address - Street 1:116 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELDERTON
Practice Address - State:PA
Practice Address - Zip Code:15736-0148
Practice Address - Country:US
Practice Address - Phone:724-354-5258
Practice Address - Fax:724-354-4396
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD429722OtherMEDICAL LICENSE