Provider Demographics
NPI:1619949534
Name:MICELI, CHRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MICELI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:MICELI-HAHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 638269
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18780 BAGLEY RD STE 108
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3304
Practice Address - Country:US
Practice Address - Phone:440-816-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-001156363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000329801OtherANTHEM
OH000000360051OtherANTHEM
OHH213880Medicare PIN
OH000000329801OtherANTHEM
OH000000360051OtherANTHEM
OHQ11946Medicare UPIN