Provider Demographics
NPI:1548292030
Name:FLIS, PAWEL R (MD)
Entity type:Individual
Prefix:
First Name:PAWEL
Middle Name:R
Last Name:FLIS
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:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16804-1230
Mailing Address - Country:US
Mailing Address - Phone:814-235-3898
Mailing Address - Fax:814-235-3899
Practice Address - Street 1:1800 E PARK AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6701
Practice Address - Country:US
Practice Address - Phone:814-231-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421968207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA80917OtherGEISINGER HEALTH PLAN
PA50041425OtherKEYSTONE HEALTH PLAN CENT
PA0019672370002Medicaid
PA1505399OtherHIGHMARK BLUE SHIELD
PA50041425OtherCAPITAL BLUE CROSS
PA0019672370002Medicaid
PA1505399OtherHIGHMARK BLUE SHIELD
PAP00057282Medicare ID - Type UnspecifiedRAILROAD MEDICARE