Organization
ORTHOPAEDIC CONSULTANTS OF WYOMING VALLEY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL C RAKLEWICZ MD (PARTNER)
(570) 288-3535
Entity
Organization
Contact information
Practice address
390 PIERCE ST, KINGSTON, PA 18704-5532
(570) 288-3535
(570) 288-0804
Mailing address
PO BOX 1463, KINGSTON, PA 18704-0463
(570) 288-3535
(570) 288-0804
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018536010001
—
PA
01
—
925341
BLUE SHIELD
PA
Enumeration date
08/13/2006
Last updated
08/22/2020
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