Healthcare Provider Details

I. General information

NPI: 1184689051
Provider Name (Legal Business Name): GAETANO CIANCIO MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NW 9TH AVE FL 3 HIGHLAND PROFESSIONAL BLDG.
MIAMI FL
33136-1124
US

IV. Provider business mailing address

1801 NW 9TH AVE FL 3 HIGHLAND PROFESSIONAL BLDG.
MIAMI FL
33136-1124
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-5111
  • Fax: 305-355-5234
Mailing address:
  • Phone: 305-355-5111
  • Fax: 305-355-5234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberME52984
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: