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NPI Code Detail

MEDICARE: MATTHEW CIANCIOLO DO

MEDICARE: MATTHEW CIANCIOLO DO
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
1207Q00000XFamily Medicine Physician2006004613MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053362681
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW CIANCIOLO DO
Provider Business Mailing Address
First Line : 901 E. 104TH ST.
Second Line : MAILSTOP 400N
City : KANSAS CITY
State : MO
Zip : 64131-9712
Country : US
Telephone Number : 816-502-7104
Fax Number : 816-932-9670
Provider Business Practice Location Address
First Line : 20 NE SAINT LUKES BLVD
Second Line : STE. 200
City : LEES SUMMIT
State : MO
Zip : 64086-6001
Country : US
Telephone Number : 813-347-5100
Fax Number : 816-347-5136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 02/22/2018

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Directions to “ MATTHEW CIANCIOLO DO” Practice Location

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