Provider Demographics
NPI:1972728400
Name:SALATA, MICHAEL JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JONATHAN
Last Name:SALATA
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 1:24701 EUCLID AVENUE
Mailing Address - Street 2:3RD FLOOR, MAIL STOP NET 6099
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:216-844-5970
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123170207XX0005X
OH35.095437207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3071974Medicaid
IL9980399OtherAETNA
OH000000313137OtherUNISON
PA1025613910001Medicaid
IL1633878OtherBCBS
OH561814OtherWELLCARE
OHP00891147OtherRAILROAD MEDICARE
OH2048816199CSOtherCARESOURCE
OHP00891147OtherRAILROAD MEDICARE
OHSA4299821Medicare PIN
OH2048816199CSOtherCARESOURCE