Provider Demographics
NPI:1518016815
Name:MILETI, MARK ANTHONY
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:MILETI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5957 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2868
Mailing Address - Country:US
Mailing Address - Phone:440-884-6333
Mailing Address - Fax:440-888-0683
Practice Address - Street 1:5957 STATE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2868
Practice Address - Country:US
Practice Address - Phone:440-884-6333
Practice Address - Fax:440-888-0683
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-09-18
Deactivation Date:2007-01-23
Deactivation Code:
Reactivation Date:2018-01-10
Provider Licenses
StateLicense IDTaxonomies
OH01374237700000X
OH3064-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist