MEDICARE: CARL J SICILIANO DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	TN0000000422	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00450580	OTHER	TN	MEDICARE ID TYPE UNSPECIFIED

General Provider Information

NPI Number	:	1922056431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL J SICILIANO DPM

Provider Business Mailing Address
First Line	:	7424 HIGHWAY 64
Second Line	:	SUITE 119
City	:	BARTLETT
State	:	TN
Zip	:	38135
Country	:	US
Telephone Number	:	901-381-2800
Fax Number	:	901-381-2677

Provider Business Practice Location Address
First Line	:	7424 US HIGHWAY 64
Second Line	:	STE 119
City	:	BARTLETT
State	:	TN
Zip	:	38135
Country	:	US
Telephone Number	:	901-381-2800
Fax Number	:	901-381-2677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	06/05/2008

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