Provider Demographics
NPI:1679557011
Name:SCOLIERI, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:SCOLIERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7790 CEDAR PARK DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-7700
Mailing Address - Country:US
Mailing Address - Phone:330-702-1860
Mailing Address - Fax:
Practice Address - Street 1:885 S SAWBURG RD
Practice Address - Street 2:STE 105
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-5905
Practice Address - Country:US
Practice Address - Phone:330-823-1112
Practice Address - Fax:330-823-1139
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071208800000X
OH35-0715772088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH340020570OtherRAILROAD MEDICARE
OH2240793Medicaid
OH340020570OtherRAILROAD MEDICARE
OH4238110001Medicare NSC
H35365Medicare UPIN