DR. LEO MICHAEL MICHALEK JR. MD NPI 1003801366

General Practice in Lackawanna, NY

Individual Male General Practice PECOS Enrolled Accepts Medicare Years Experience 56

About LEO MICHALEK

Leo Michalek is a provider established in Lackawanna, New York and his medical specialization is general practice with more than 56 years of experience. The NPI number of Leo Michalek is 1003801366 and was assigned on September 2005. The practitioner's primary taxonomy code is 208D00000X with license number 094920 (NY). The provider is registered as an individual and his NPI record was last updated 9 years ago. Leo Michalek is enrolled in PECOS and registered with Medicare but might not accept claims assignment.

NPI

1003801366

Provider NameDR. LEO MICHAEL MICHALEK JR. MD
Provider Location Address561 RIDGE RD LACKAWANNA, NY 14218
Provider Mailing Address550 CENTER RD WEST SENECA, NY 14224
GenderMale
NPI Entity TypeIndividual
Medical School NameSTATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE
Graduation Year1964
Is Sole Proprietor?Yes
Is Organization Subpart?N/A
Enumeration Date09-13-2005
Last Update Date05-05-2010

Primary Taxonomy

Taxonomy Code208D00000X
ClassificationGeneral Practice
TypeAllopathic & Osteopathic Physicians
License No.094920
License StateNY

Business Address

DR. LEO MICHAEL MICHALEK JR. MD
561 RIDGE RD
LACKAWANNA, NY
ZIP 14218
Phone: (716) 823-0141
Fax: (716) 822-5468

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Mailing Address

DR. LEO MICHAEL MICHALEK JR. MD
550 CENTER RD
WEST SENECA, NY
ZIP 14224
Phone: (716) 677-0100
Fax: (716) 677-0200

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
00010118401OTHER (01)
C58031MEDICARE UPIN (02)
1700291OTHER (01)
053341MEDICARE ID-TYPE UNSPECIFIED (04)NY
000505334001OTHER (01)
00601643MEDICAID (05)NY

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.

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