MEDICARE: MR. CICERO L SADLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1013422492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CICERO L SADLER

Provider Business Mailing Address
First Line	:	PO BOX 8125
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77288-8125
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 SAN JACINTO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4021
Country	:	US
Telephone Number	:	713-522-9515
Fax Number	:	713-522-9515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2017
Last Update Date	:	12/07/2017

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