Provider Demographics
NPI:1871587394
Name:ONDICH, MICHAEL P (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:ONDICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ONDICH
Other - Middle Name:RURAL
Other - Last Name:HEALTH CENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10261 STATE ROUTE 85
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-8165
Mailing Address - Country:US
Mailing Address - Phone:724-783-7124
Mailing Address - Fax:724-783-7999
Practice Address - Street 1:10261 STATE ROUTE 85
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-8165
Practice Address - Country:US
Practice Address - Phone:724-783-7124
Practice Address - Fax:724-783-7999
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006237L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010616OtherGATEWAY
PA203221OtherUPMC
PA13484OtherUMW
PA534197OtherBLUE SHIELD
PA1007508360006Medicaid
PA480354OtherAETNA
PAE52875Medicare UPIN
PA13484OtherUMW
PA393834Medicare Oscar/Certification