Individual
MICHAEL A CERULLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9000
Mailing address
4464 S DIXIE HWY, MIDDLETOWN, OH 45005-5464
(513) 649-8008
(513) 649-8004
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036171397
IL
2084P0800X
Psychiatry Physician
35086733
OH
2084P0800X
Psychiatry Physician
MD61590777
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0074861
OHIO DEPARTMENT ALCOHOL DRUG SERVICES (ODADAS)
OH
01
—
0074946
OHIO DEPARTMENT MENTAL HEALTH (ODMH)
—
01
—
01-0693
CARF CERTIFICATION
OH
01
—
H297803
MEDICARE INDIVIDUAL PTAN
OH
01
—
P00356887
MEDICARE RAILROAD
OH
Enumeration date
11/21/2006
Last updated
11/14/2024
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