Individual
MS. KIMBERLY SUE CICCERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
396 PORTLAND WAY NORTH, GALION, OH 44833
(419) 468-3668
(419) 462-5037
Mailing address
3255 E LIVINGSTON AVE, PO BOX 27940, COLUMBUS, OH 43227-1923
(614) 239-9444
(614) 239-1080
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
36003436
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000252794
UNISON
OH
01
—
000000580187
ANTHEM
OH
01
—
1366529653
MEDICARE NPI
OH
01
—
1699074393
MEDICARE NPI
OH
05
—
2657843
—
OH
01
—
310945970
GREAT WEST
OH
01
—
5340555
CIGNA
OH
01
—
7970774
AETNA
OH
01
—
986832
COVENTRY
OH
Enumeration date
05/17/2006
Last updated
09/25/2012
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