Healthcare Provider Details

I. General information

NPI: 1679308043
Provider Name (Legal Business Name): MARCUS A CICERO CPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7969 STATE RD
NORTH ROYALTON OH
44133-2036
US

IV. Provider business mailing address

8800 CHRISTOPHER DR
NORTH ROYALTON OH
44133-2126
US

V. Phone/Fax

Practice location:
  • Phone: 440-390-0226
  • Fax:
Mailing address:
  • Phone: 440-390-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number4002763
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: