Provider Demographics
NPI:1962473082
Name:MIKLASHEK, GREELEY G (MD)
Entity Type:Individual
Prefix:DR
First Name:GREELEY
Middle Name:G
Last Name:MIKLASHEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 PECK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-2507
Mailing Address - Country:US
Mailing Address - Phone:231-725-8143
Mailing Address - Fax:231-722-6484
Practice Address - Street 1:1735 PECK ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2507
Practice Address - Country:US
Practice Address - Phone:231-725-8143
Practice Address - Fax:231-722-6484
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010612192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M74350Medicare ID - Type Unspecified
MI0P28140003Medicare ID - Type Unspecified
MIB74395Medicare UPIN