=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730170713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSOCIATES IN GASTROENTEROLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2005
-----------------------------------------------------
Last Update Date | 06/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 575 LINCOLN AVE LOWER LEVEL
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15202-3550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-933-1420
-----------------------------------------------------
Fax | 724-933-1439
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5500 BROOKTREE RD SUITE 201
-----------------------------------------------------
City | WEXFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15090-9260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-933-1420
-----------------------------------------------------
Fax | 724-933-1439
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL L MLECKO
-----------------------------------------------------
Credential | M.D..
-----------------------------------------------------
Telephone | 724-933-1420
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------