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Individual

DR. MICHAEL L CICCOLO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3201 S MARYLAND PKWY STE 220, LAS VEGAS, NV 89109-2424
(702) 961-9290
Mailing address
PO BOX 100744, ATLANTA, GA 30384-0744

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
9463
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100500157
NV
05
20-18427
NV
Enumeration date
02/27/2007
Last updated
03/07/2025
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