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General NPI Number Information
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NPI Number | 1134135536
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Entity Type | Individual
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Provider Name | RICHARD D CECCONI MD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1711 S STEPHENSON AVE SUITE 305
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-3637
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Country | US
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Telephone | 906-774-0330
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Fax | 906-774-2584
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Provider Business Mailing Address
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Address Line | 1711 S STEPHENSON AVE SUITE 305
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-3637
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Country | US
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Telephone | 906-774-0330
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Fax | 906-774-2584
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301047328
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License Number State | MI
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