Healthcare Provider Details

I. General information

NPI: 1275505661
Provider Name (Legal Business Name): KAREN M MIHALIK- POTOCZAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN MIHALIK M.D.

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 NORTH LEAVITT RD
AMHERST OH
44001
US

IV. Provider business mailing address

590 NORTH LEAVITT RD
AMHERST OH
44001
US

V. Phone/Fax

Practice location:
  • Phone: 440-985-3050
  • Fax: 440-985-3065
Mailing address:
  • Phone: 440-985-3050
  • Fax: 440-985-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35061156M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: