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General NPI Number Information
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NPI Number | 1265472211
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Entity Type | Organization
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Legal Business Name | SIWICKI & RICCIARDI,P.L.
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 341 A RACETRACK RD NW
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547
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Country | US
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Telephone | 850-862-4119
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Fax |
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Provider Business Mailing Address
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Address Line | 341 RACETRACK RD NW STE A
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1788
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Country | US
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Telephone | 850-862-4119
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Fax | 850-862-5470
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Authorized Official
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Title or Position | CEO
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Name | DR. COSIMO A RICCIARDI
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Credential | D.P.M.
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Telephone | 850-862-4119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO1110 & PO2964
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License Number State | FL
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