Basic Information
| Provider Information | |||||||||
| NPI: | 1609369214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COCCIMIGLIO | ||||||||
| FirstName: | ELISA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N SUMMIT ST FL 7 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174862411 | ||||||||
| FaxNumber: | 0000000000 | ||||||||
| Practice Location | |||||||||
| Address1: | 157 W BROOKE LN | ||||||||
| Address2: | |||||||||
| City: | BLISSFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492288601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174862411 | ||||||||
| FaxNumber: | 5174863967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2018 | ||||||||
| LastUpdateDate: | 07/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301115137 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.