# SERRIE C. LICO MD, CARDIOVASCULAR & THORACIC SURGERY PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093036659
- **Authorized official:** DR. SERRIE C. LICO M.D. (PRESIDENT)
- **Authorized official phone:** (716) 821-7714

## Contact information

- **Practice address:** 515 ABBOTT RD, SUITE 101, BUFFALO, NY 14220-1700
- **Practice address phone:** (716) 821-7714
- **Practice address fax:** (716) 821-7716
- **Mailing address:** PO BOX 24, ORCHARD PARK, NY 14127-0024
- **Mailing address phone:** (716) 821-7714
- **Mailing address fax:** (716) 821-7716

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 184556-1 | NY | Yes |

## Other

- **Enumeration date:** 06/17/2010
- **Last updated:** 01/22/2013