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1538126057

NPI Code Detail

MEDICARE: MARY CICCARELLI MD

MEDICARE: MARY CICCARELLI MD

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	208000000X	Pediatrics Physician	01039620A	IN
2	207R00000X	Internal Medicine Physician	01039620A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000086725	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538126057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CICCARELLI MD

Provider Business Mailing Address
First Line	:	PO BOX 719094
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-9318
Country	:	US
Telephone Number	:	317-777-6435
Fax Number	:	317-777-6644

Provider Business Practice Location Address
First Line	:	2505 N ARLINGTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-3318
Country	:	US
Telephone Number	:	317-554-5200
Fax Number	:	317-554-5247

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	02/13/2026

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Directions to “ MARY CICCARELLI MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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