Healthcare Provider Details

I. General information

NPI: 1538155593
Provider Name (Legal Business Name): MATTHEW J FICENEC MD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 3RD ST SUITE 8
CORPUS CHRISTI TX
78404-2354
US

IV. Provider business mailing address

1224 3RD ST SUITE 8
CORPUS CHRISTI TX
78404-2354
US

V. Phone/Fax

Practice location:
  • Phone: 361-985-9403
  • Fax: 361-881-9566
Mailing address:
  • Phone: 361-985-9403
  • Fax: 361-881-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL2886
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: