Healthcare Provider Details

I. General information

NPI: 1619062825
Provider Name (Legal Business Name): GENE CAICCO,D.P.M., PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 E 12 MILE RD SUITE 102
WARREN MI
48093-3487
US

IV. Provider business mailing address

11900 E 12 MILE RD SUITE 102
WARREN MI
48093-3487
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-7470
  • Fax: 586-573-0850
Mailing address:
  • Phone: 586-573-7470
  • Fax: 586-573-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901001745
License Number StateMI

VIII. Authorized Official

Name: DR. GENE JOSEPH CAICCO
Title or Position: OWNER PODIATRIST
Credential: D.P.M.
Phone: 586-573-7470