Provider Demographics
NPI:1477741593
Name:MICHAEL T. CILETTIM.D., INC
Entity Type:Organization
Organization Name:MICHAEL T. CILETTIM.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CILETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-652-5455
Mailing Address - Street 1:425 ROBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-2409
Mailing Address - Country:US
Mailing Address - Phone:330-652-5455
Mailing Address - Fax:330-652-1689
Practice Address - Street 1:425 ROBBINS AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-2409
Practice Address - Country:US
Practice Address - Phone:330-652-5455
Practice Address - Fax:330-652-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0849701Medicaid
OH0849701Medicaid
OHE84381Medicare UPIN