Provider Demographics
NPI:1891975348
Name:CHERYL A COLLETTI DO PLLC
Entity Type:Organization
Organization Name:CHERYL A COLLETTI DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-787-6779
Mailing Address - Street 1:517 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1094
Mailing Address - Country:US
Mailing Address - Phone:517-787-6779
Mailing Address - Fax:517-787-6794
Practice Address - Street 1:517 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1094
Practice Address - Country:US
Practice Address - Phone:517-787-6779
Practice Address - Fax:517-787-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION84730Medicare PIN