MEDICARE: CHRISTOPHER P KICZEK M.D.

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	207R00000X	Internal Medicine Physician	35057943	OH

General Provider Information

NPI Number	:	1568454478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER P KICZEK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 567
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-0567
Country	:	US
Telephone Number	:	216-464-5160
Fax Number	:	216-464-5982

Provider Business Practice Location Address
First Line	:	2174 WARRENSVILLE CENTER RD
Second Line	:
City	:	UNIVERSITY HTS
State	:	OH
Zip	:	44118-3125
Country	:	US
Telephone Number	:	216-381-9000
Fax Number	:	216-381-2151

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/09/2007

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