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General NPI Number Information
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NPI Number | 1114939451
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDIC CONSULTANTS OF WYOMING VALLEY LLC
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 390 PIERCE ST
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City | KINGSTON
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State | PA
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Zip | 18704-5532
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Country | US
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Telephone | 570-288-3535
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Fax | 570-288-0804
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Provider Business Mailing Address
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Address Line | PO BOX 1463
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City | KINGSTON
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State | PA
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Zip | 18704-0463
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Country | US
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Telephone | 570-288-3535
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Fax | 570-288-0804
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MICHAEL C RAKLEWICZ
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Credential | MD
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Telephone | 570-288-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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