MEDICARE: KENNETH CIOLLI 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	207Q00000X	Family Medicine Physician	H5283	TX

General Provider Information

NPI Number	:	1891792545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH CIOLLI MD

Provider Business Mailing Address
First Line	:	8637 FREDERICKSBURG RD
Second Line	:	#360
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1285
Country	:	US
Telephone Number	:	210-949-4179
Fax Number	:	210-617-4075

Provider Business Practice Location Address
First Line	:	6218 NW LOOP 410
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-3306
Country	:	US
Telephone Number	:	210-523-1411
Fax Number	:	210-523-9307

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/22/2008

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