Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 000833 | CT |
Y | 222Z00000X | Podiatrist | 000833 | CT |
NPI | 1063670016 |
---|---|
Provider Name | Michael D A Cicero |
First Address | Wellesley, MA 02482-3744 |
Second Address | Middletown, CT 06457-7568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 07/02/2018 |