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General NPI Number Information
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NPI Number | 1083666036
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Entity Type | Individual
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Provider Name | KIMBERLY SUE CICCERO DPM
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 396 PORTLAND WAY NORTH
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City | GALION
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State | OH
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Zip | 44833
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Country | US
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Telephone | 419-468-3668
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Fax | 419-462-5037
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Provider Business Mailing Address
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Address Line | 3255 E LIVINGSTON AVE PO BOX 27940
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City | COLUMBUS
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State | OH
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Zip | 43227-1923
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Country | US
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Telephone | 614-239-9444
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Fax | 614-239-1080
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 36003436
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License Number State | OH
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