Healthcare Provider Details

I. General information

NPI: 1245214337
Provider Name (Legal Business Name): MICHAEL A JALOWIEC D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 HILLSIDE DR
CLARKS SUMMIT PA
18411-9505
US

IV. Provider business mailing address

1451 HILLSIDE DR
CLARKS SUMMIT PA
18411-9505
US

V. Phone/Fax

Practice location:
  • Phone: 570-586-2011
  • Fax:
Mailing address:
  • Phone: 570-586-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS007959L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: