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General NPI Number Information
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NPI Number | 1790961514
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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 | 01/10/2008
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Last Update Date | 03/26/2019
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Provider Practice Location Address
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Address Line | 120 E REDSTONE AVE STE A
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City | CRESTVIEW
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State | FL
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Zip | 32539-5370
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Country | US
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Telephone | 850-682-6522
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Fax |
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Provider Business Mailing Address
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Address Line | 914A MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6706
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Country | US
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Telephone | 850-862-4119
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Fax |
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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 | P01110 & P02964
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License Number State | FL
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