Basic Information
| Provider Information | |||||||||
| NPI: | 1598760225 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOMCZAK | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | JOAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 PINE AVE | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165042316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148775800 | ||||||||
| FaxNumber: | 8148775809 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 PINE AVE | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165042316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148775800 | ||||||||
| FaxNumber: | 8148775809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 04/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS008255L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.