Provider Demographics
NPI:1982682894
Name:ZELEZNIK, MIROSLAV (MD)
Entity Type:Individual
Prefix:
First Name:MIROSLAV
Middle Name:
Last Name:ZELEZNIK
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 1:312 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1418
Mailing Address - Country:US
Mailing Address - Phone:724-238-5667
Mailing Address - Fax:724-238-5667
Practice Address - Street 1:312 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1418
Practice Address - Country:US
Practice Address - Phone:724-238-5667
Practice Address - Fax:724-238-5667
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036428L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005986200001Medicaid
ZE136705OtherBCBS WEST PA
PA0005986200001Medicaid
PA2E136705Medicare ID - Type Unspecified