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General NPI Number Information
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NPI Number | 1679578272
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Entity Type | Individual
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Provider Name | LOUIS MICELI DO
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Gender | Male
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 3125 WILLOWCREEK RD
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City | PORTAGE
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State | IN
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Zip | 46368-4423
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Country | US
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Telephone | 219-762-3175
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Fax | 219-763-3092
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Provider Business Mailing Address
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Address Line | 2022 KELLE DR
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City | CHESTERTON
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State | IN
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Zip | 46304-8708
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Country | US
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Telephone | 219-364-3616
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Fax | 219-364-3610
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 02000622
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02000622
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License Number State | IN
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