Provider Demographics
NPI:1528052834
Name:PELACHYK, JOHN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:PELACHYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9280 BARTEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MI
Mailing Address - Zip Code:48063-4204
Mailing Address - Country:US
Mailing Address - Phone:586-727-3643
Mailing Address - Fax:
Practice Address - Street 1:9280 BARTEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MI
Practice Address - Zip Code:48063-4204
Practice Address - Country:US
Practice Address - Phone:586-727-3643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042820207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0707411271OtherBCBSM
MI0707411271OtherBCBS FED EMPLOYEE PROGRAM
MI104498OtherPREFERRED CHOICES
MI104498OtherCARE CHOICES
MI17809OtherGREAT LAKES HEALTH PLAN
MIE19114OtherHEALTH ALLIANCE PLAN
MI0707411271OtherBLUE CARE NETWORK
MI4036644OtherAETNA
MIE19114Medicare UPIN
MI2718380Medicaid
MI0740820Medicare PIN