Provider Demographics
NPI:1609694819
Name:FUSECK, MICHELE
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:FUSECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23937 ELM RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3731
Mailing Address - Country:US
Mailing Address - Phone:440-787-1383
Mailing Address - Fax:
Practice Address - Street 1:3600 KOLBE RD STE 127
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1652
Practice Address - Country:US
Practice Address - Phone:440-989-1800
Practice Address - Fax:440-989-1801
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPP-000875061RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant