Provider Demographics
NPI:1770595027
Name:RAKLEWICZ, MICHAEL C (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:RAKLEWICZ
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:PO BOX 1463
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0463
Mailing Address - Country:US
Mailing Address - Phone:570-288-3535
Mailing Address - Fax:570-288-0804
Practice Address - Street 1:390 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5532
Practice Address - Country:US
Practice Address - Phone:570-288-3535
Practice Address - Fax:570-288-0804
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014960E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006104670005Medicaid
PA90067OtherBLUE SHIELD
PA90067OtherBLUE SHIELD
PA0006104670005Medicaid