Provider Demographics
NPI:1831662105
Name:MICHELE L. FLACK, D.O., LLC
Entity Type:Organization
Organization Name:MICHELE L. FLACK, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-367-4443
Mailing Address - Street 1:PO BOX 933300
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0037
Mailing Address - Country:US
Mailing Address - Phone:937-367-4443
Mailing Address - Fax:
Practice Address - Street 1:3718 WHISPER CREEK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2570
Practice Address - Country:US
Practice Address - Phone:937-367-4443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty