Healthcare Provider Details

I. General information

NPI: 1750389011
Provider Name (Legal Business Name): MICHAEL THOMAS CILETTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/21/2006

III. Provider practice location address

425 ROBBINS AVE
NILES OH
44446-2409
US

IV. Provider business mailing address

425 ROBBINS AVE
NILES OH
44446-2409
US

V. Phone/Fax

Practice location:
  • Phone: 330-652-5455
  • Fax: 330-652-1689
Mailing address:
  • Phone: 330-652-5455
  • Fax: 330-652-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35061086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: