Provider Demographics
NPI:1164471793
Name:COLANGELO, MICHELE M (DO)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:COLANGELO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 NORTHCLIFF AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3267
Mailing Address - Country:US
Mailing Address - Phone:216-398-5988
Mailing Address - Fax:216-398-5832
Practice Address - Street 1:7575 NORTHCLIFF AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-3267
Practice Address - Country:US
Practice Address - Phone:216-398-5988
Practice Address - Fax:216-398-5832
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006944207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2160405Medicaid
OH2160405Medicaid
H09972Medicare UPIN
OH4248881Medicare PIN