Healthcare Provider Details

I. General information

NPI: 1679539035
Provider Name (Legal Business Name): MICHELE RALOFSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 STATE ROUTE 60 SUITE 6
VERMILION OH
44089
US

IV. Provider business mailing address

1957 COOPER FOSTER PARK RD
AMHERST OH
44001-1207
US

V. Phone/Fax

Practice location:
  • Phone: 440-967-8713
  • Fax: 440-967-1938
Mailing address:
  • Phone: 440-988-1009
  • Fax: 440-988-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35073433R
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: