Basic Information
| Provider Information | |||||||||
| NPI: | 1417432451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISTOPHER | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 434 EAGLE ST | ||||||||
| Address2: | |||||||||
| City: | FAIRPORT HARBOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440775805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406375606 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 400 TUSCARAWAS ST W | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447022044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304382400 | ||||||||
| FaxNumber: | 3304550621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2018 | ||||||||
| LastUpdateDate: | 09/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | OH | Y |
No ID Information.