Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD025779E | PA |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD025779E | PA |
NPI | 1013905884 |
---|---|
Provider Name | Michael J Pelekanos |
First Address | Monroeville, PA 15146-3500 |
Second Address | Monroeville, PA 15146-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 06/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001021391 | (05) | PA |
B41360 | (02) | PA |