Provider Demographics
NPI:1295715035
Name:VACANTE, MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:VACANTE
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 1:125 E BROAD ST STE 305
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6447
Mailing Address - Country:US
Mailing Address - Phone:440-414-9100
Mailing Address - Fax:216-201-5578
Practice Address - Street 1:125 E BROAD ST
Practice Address - Street 2:SUITE 305
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6400
Practice Address - Country:US
Practice Address - Phone:440-414-9100
Practice Address - Fax:216-201-5578
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003658207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060013317OtherRAILROAD MEDICARE
OHE03658OtherSUMMACARE
OH341221800074OtherCARESOURCE
OH000000128694OtherANTHEM
OH0623810Medicaid
OH100400OtherKAISER
OHE03658OtherSUMMACARE
OHA17624Medicare UPIN