Individual
DR. MICHAEL VACANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
125 E BROAD ST, SUITE 305, ELYRIA, OH 44035-6400
(440) 414-9100
(216) 201-5578
Mailing address
125 E BROAD ST STE 305, ELYRIA, OH 44035-6447
(440) 414-9100
(216) 201-5578
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
34003658
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000128694
ANTHEM
OH
01
—
060013317
RAILROAD MEDICARE
—
05
—
0623810
—
OH
01
—
100400
KAISER
OH
01
—
341221800074
CARESOURCE
OH
01
—
E03658
SUMMACARE
OH
Enumeration date
01/18/2006
Last updated
01/07/2021
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