MEDICARE: JOHN D MOLESKY DO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34-002839M	OH

General Provider Information

NPI Number	:	1336460880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN D MOLESKY DO INC

Provider Business Mailing Address
First Line	:	550 MOTE DR STE 2
Second Line	:
City	:	COVINGTON
State	:	OH
Zip	:	45318-1273
Country	:	US
Telephone Number	:	937-473-3025
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 MOTE DR STE 2
Second Line	:
City	:	COVINGTON
State	:	OH
Zip	:	45318-1273
Country	:	US
Telephone Number	:	937-473-3025
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JOHN D MOLESKY
Credential	:	D.O.
Telephone Number	:	937-473-3025

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	06/18/2010

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