Healthcare Provider Details

I. General information

NPI: 1699821009
Provider Name (Legal Business Name): JOSEPH C CICENIA III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE A90
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE A90
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-8606
  • Fax: 216-445-0474
Mailing address:
  • Phone: 216-445-8606
  • Fax: 216-445-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number217694
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.096266
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: