MEDICARE: CHRISTIAN COLETTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	35.141745	OH

General Provider Information

NPI Number	:	1821592718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN COLETTA MD

Provider Business Mailing Address
First Line	:	9800 SHELBYVILLE RD STE 220
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-2992
Country	:	US
Telephone Number	:	502-429-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 COLUMBUS PIKE STE 70
Second Line	:
City	:	DELAWARE
State	:	OH
Zip	:	43015-2728
Country	:	US
Telephone Number	:	740-371-9721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	06/16/2023

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