Healthcare Provider Details

I. General information

NPI: 1861563389
Provider Name (Legal Business Name): MR. MICHAEL JAMES CICHANOWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WINGHURST BLVD
ORLANDO FL
32828-8058
US

IV. Provider business mailing address

100 WINGHURST BLVD
ORLANDO FL
32828-8058
US

V. Phone/Fax

Practice location:
  • Phone: 407-273-4235
  • Fax: 407-273-4235
Mailing address:
  • Phone: 407-273-4235
  • Fax: 407-273-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number3501-0006722
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: