Healthcare Provider Details

I. General information

NPI: 1184202681
Provider Name (Legal Business Name): MICHAEL CARLO NILO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL NILO MD

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SMITHFIELD LANE
EAST STROUDSBURG PA
18301-8704
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 272-212-3872
  • Fax:
Mailing address:
  • Phone: 484-526-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD484304
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: