Healthcare Provider Details

I. General information

NPI: 1568806958
Provider Name (Legal Business Name): JESSICA CICERO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA GERMAN PA

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 07/29/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 ELLIOTT DRIVE SUITE 304
YPSILANTI MI
48197
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DRIVE SUITE J2000
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-0655
  • Fax: 734-712-0611
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601012336
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: