Individual
DR. MICHAEL J DECICCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 NORTH ST, SUITE 301, GENEVA, NY 14456-1561
(315) 787-5353
(315) 787-5350
Mailing address
200 NORTH ST, SUITE 301, GENEVA, NY 14456-1561
(315) 787-5353
(315) 787-5350
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
220674
NY
207YP0228X
Pediatric Otolaryngology Physician
220674
NY
207YS0123X
Facial Plastic Surgery Physician
220674
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02171671
—
NY
Enumeration date
07/26/2006
Last updated
07/06/2023
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