Individual
CHRISTINE MICELI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
18780 BAGLEY RD STE 108, CLEVELAND, OH 44130-3304
(440) 816-2330
Mailing address
PO BOX 638269, CINCINNATI, OH 45263-8269
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50-001156
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000329801
ANTHEM
OH
01
—
000000360051
ANTHEM
OH
Enumeration date
02/03/2006
Last updated
08/04/2023
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