Healthcare Provider Details

I. General information

NPI: 1013905884
Provider Name (Legal Business Name): MICHAEL J PELEKANOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 HAYMAKER RD STE 201
MONROEVILLE PA
15146-3500
US

IV. Provider business mailing address

2580 HAYMAKER RD STE 201
MONROEVILLE PA
15146-3500
US

V. Phone/Fax

Practice location:
  • Phone: 412-856-7500
  • Fax: 412-856-6079
Mailing address:
  • Phone: 412-856-7500
  • Fax: 412-856-6079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD025779E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD025779E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: