Healthcare Provider Details

I. General information

NPI: 1730170713
Provider Name (Legal Business Name): ASSOCIATES IN GASTROENTEROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 LINCOLN AVE LOWER LEVEL
BELLEVUE PA
15202-3550
US

IV. Provider business mailing address

5500 BROOKTREE RD SUITE 201
WEXFORD PA
15090-9260
US

V. Phone/Fax

Practice location:
  • Phone: 724-933-1420
  • Fax: 724-933-1439
Mailing address:
  • Phone: 724-933-1420
  • Fax: 724-933-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL L MLECKO
Title or Position: PRESIDENT
Credential: M.D..
Phone: 724-933-1420