Provider Demographics
NPI:1750389011
Name:CILETTI, MICHAEL THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:CILETTI
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 1:425 ROBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-2409
Mailing Address - Country:US
Mailing Address - Phone:330-652-5455
Mailing Address - Fax:330-652-1689
Practice Address - Street 1:425 ROBBINS AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-2409
Practice Address - Country:US
Practice Address - Phone:330-652-5455
Practice Address - Fax:330-652-1689
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2009-11-18
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
OH35061086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0849701Medicaid
OHCI0692182Medicare ID - Type UnspecifiedIND MEDICARE #
OHE84381Medicare UPIN