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General NPI Number Information
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NPI Number | 1063581395
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Entity Type | Individual
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Provider Name | MICHAEL CLIFFORD CARLISLE DO
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 13207 RAVENNA RD SENIOR ASSESSMENT PROGRAM
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City | CHARDON
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State | OH
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Zip | 44024-7032
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Country | US
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Telephone | 216-844-2400
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Fax | 440-285-6247
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Provider Business Mailing Address
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Address Line | 24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
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City | EUCLID
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State | OH
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Zip | 44117-1714
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Country | US
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Telephone | 216-844-2400
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Fax | 440-285-6247
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 34008772
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License Number State | OH
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