Basic Information
| Provider Information | |||||||||
| NPI: | 1679557011 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOLIERI | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7790 CEDAR PARK DR | ||||||||
| Address2: | |||||||||
| City: | CANFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444067700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307021860 | ||||||||
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| Practice Location | |||||||||
| Address1: | 885 S SAWBURG RD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | ALLIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446015905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308231112 | ||||||||
| FaxNumber: | 3308231139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 10/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 35071 | OH | Y | Allopathic & Osteopathic Physicians | Urology | 2088F0040X | 35-071577 | OH | N | Allopathic & Osteopathic Physicians | Urology | Female Pelvic Medicine and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 340020570 | 01 | OH | RAILROAD MEDICARE | OTHER | 2240793 | 05 | OH | MEDICAID |