Individual
MATTHEW MICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 PROSPECT AVE, SYRACUSE, NY 13203-1807
(315) 448-5536
Mailing address
301 PROSPECT AVE, SYRACUSE, NY 13203-1807
(315) 448-5536
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
D92459
MD
208M00000X
Hospitalist Physician
Primary
D92459
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/17/2018
Last updated
10/11/2021
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