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General NPI Number Information
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NPI Number | 1891975348
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Entity Type | Organization
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Legal Business Name | CHERYL A COLLETTI DO PLLC
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 517 WILDWOOD AVE
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City | JACKSON
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State | MI
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Zip | 49201-1094
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Country | US
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Telephone | 517-787-6779
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Fax | 517-787-6794
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Provider Business Mailing Address
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Address Line | 517 WILDWOOD AVE
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City | JACKSON
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State | MI
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Zip | 49201-1094
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Country | US
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Telephone | 517-787-6779
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Fax | 517-787-6794
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHERYL A COLLETTI
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Credential | DO
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Telephone | 517-787-6779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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