Healthcare Provider Details

I. General information

NPI: 1033224290
Provider Name (Legal Business Name): ERICA K. CICHOWSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 N 16TH ST
COUNCIL BLUFFS IA
51501-0121
US

IV. Provider business mailing address

1702 N 16TH ST
COUNCIL BLUFFS IA
51501-0121
US

V. Phone/Fax

Practice location:
  • Phone: 712-256-7223
  • Fax: 712-256-7669
Mailing address:
  • Phone: 712-256-7223
  • Fax: 712-256-7669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22017
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: