Provider Demographics
NPI:1447221643
Name:KALETA, MICHELE D (MD)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:D
Last Name:KALETA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BOYMEL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5526
Mailing Address - Country:US
Mailing Address - Phone:513-874-9460
Mailing Address - Fax:513-874-5731
Practice Address - Street 1:5900 BOYMEL DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5526
Practice Address - Country:US
Practice Address - Phone:513-874-9460
Practice Address - Fax:513-874-5731
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070776208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0279596Medicaid
OHG44177Medicare UPIN