Provider Demographics
NPI:1104827211
Name:AMALFITANO, MICHAEL L (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:AMALFITANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NEAL ZICK RD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-9287
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 NEAL ZICK RD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9287
Practice Address - Country:US
Practice Address - Phone:419-694-5080
Practice Address - Fax:419-694-5080
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.005299207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0838660Medicaid
OH0838660Medicaid
OH7424851Medicare PIN