Healthcare Provider Details

I. General information

NPI: 1972728400
Provider Name (Legal Business Name): MICHAEL JONATHAN SALATA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVENUE THIRD FLOOR
CLEVELAND OH
44106
US

IV. Provider business mailing address

24701 EUCLID AVENUE 3RD FLOOR, MAIL STOP NET 6099
EUCLID OH
44117
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax: 216-844-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number036123170
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35.095437
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: