Provider Demographics
NPI:1871531376
Name:COLLETTI, CHERYL ANN (DO)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:COLLETTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:517 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1094
Mailing Address - Country:US
Mailing Address - Phone:517-787-6779
Mailing Address - Fax:517-787-6794
Practice Address - Street 1:517 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1094
Practice Address - Country:US
Practice Address - Phone:517-787-6779
Practice Address - Fax:517-787-6794
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2007-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A78161Medicare UPIN
MION84730Medicare PIN