Healthcare Provider Details

I. General information

NPI: 1881696243
Provider Name (Legal Business Name): ZBIGNIEW CICHON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 01/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 JEFFERSON ST SUITE 103
NORTH WILKESBORO NC
28659-3543
US

IV. Provider business mailing address

PO BOX 1406
NORTH WILKESBORO NC
28659-1406
US

V. Phone/Fax

Practice location:
  • Phone: 336-838-1617
  • Fax: 336-838-2637
Mailing address:
  • Phone: 336-838-1617
  • Fax: 336-838-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number96-00887
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: