Provider Demographics
NPI:1679960033
Name:MACIK, KATELYN MARIE (DO)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:MACIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:MARIE
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3824 NORTHERN PIKE STE 700
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2184
Mailing Address - Country:US
Mailing Address - Phone:412-457-0060
Mailing Address - Fax:
Practice Address - Street 1:4044 ROUTE 130 STE 200
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642
Practice Address - Country:US
Practice Address - Phone:724-744-2500
Practice Address - Fax:724-744-3339
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine