Provider Demographics
NPI:1114928074
Name:ACKLEY, MICHAEL JOSPEH (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSPEH
Last Name:ACKLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3448
Mailing Address - Country:US
Mailing Address - Phone:203-271-0556
Mailing Address - Fax:203-250-9951
Practice Address - Street 1:714 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3448
Practice Address - Country:US
Practice Address - Phone:203-271-0556
Practice Address - Fax:203-250-9951
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2011-11-14
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
CT395213EP1101X, 213ES0000X, 213ES0131X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT030000395CT01OtherANTHEM BCBS
CT2V1300OtherHEALTHNET
CT480028957OtherMEDICARE RAILROAD
CT0542290OtherCIGNA
CT129286OtherFIRST CHOICE PREF ONE
CT129286OtherWELLCARE
CT2721297OtherAETNA
CTNHS221OtherOXFORD HEALTH PLAN
CT787023OtherCONNECTICARE
CT4068714Medicaid
CT129286OtherWELLCARE
CT4475020001Medicare NSC
CT0542290OtherCIGNA