Ciccolo, Michael L

Ciccolo, Michael L is an individual health care provider with primary practice located at 3131 La Canada St Ste 230 , Las Vegas NV 89169-2551. He recently has only one registered license in Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery), which is considered as his primary health care specialty. Ciccolo, Michael L can be contacted via phone (702) 732-1290.

Contact Information

Primary practice address
3131 La Canada St Ste 230 Las Vegas NV 89169-2551
Phone: (702) 732-1290
Fax: (702) 260-1926
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X 9463 Nevada

Profile Details

NPI number 1225165632
LBN Legal business name Ciccolo, Michael L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 27th, 2007
Last updated Mar 10th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225165632 NPPES
Nevada Other VWCLCQ GROUP MEDICARE #
Nevada MEDICAID 100500157 GROUP MEDICARE #
Nevada MEDICAID 20-18427 GROUP MEDICARE #

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