Individual
HEATHER R CICHANOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
435 PHALEN BLVD, MAIL STOP 51103H, SAINT PAUL, MN 55130-5302
(651) 254-8300
(651) 254-8379
Mailing address
435 PHALEN BLVD, MAIL STOP 51103H, SAINT PAUL, MN 55130-5302
(651) 254-8300
(651) 254-8379
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
46784020
WI
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
44664
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177272400
—
MN
Enumeration date
02/27/2006
Last updated
05/22/2012
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