Basic Information
| Provider Information | |||||||||
| NPI: | 1417195603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICHALUK | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HOSPITAL DR STE 306 | ||||||||
| Address2: | |||||||||
| City: | LEWISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178379350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705224110 | ||||||||
| FaxNumber: | 5707683911 | ||||||||
| Practice Location | |||||||||
| Address1: | 964 CARPENTER RD | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178477527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707422300 | ||||||||
| FaxNumber: | 5707426276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2009 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A10786 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS019559 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.