Individual
DAVID IANNICCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
15946 N BULLARD AVE, SURPRISE, AZ 85374-8844
(816) 277-2954
Mailing address
920 CENTER RD, EASTLAKE, OH 44095-2332
(440) 223-0569
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
0126000756
VA
Other
Enumeration date
04/13/2007
Last updated
07/08/2007
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