Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 04-30147 | KS |
NPI | 1205884889 |
---|---|
Provider Name | John M Ciccarelli |
First Address | Overland Park, KS 66209-3718 |
Second Address | Overland Park, KS 66209-3718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 07/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H60664 | (02) |