Individual
LYAM CICCONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
204 E 19TH ST, PANAMA CITY, FL 32405-4707
(850) 763-5409
Mailing address
20 EXCHANGE PL APT 615, NEW YORK, NY 10005-3280
(862) 251-0451
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
171344
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/17/2019
Last updated
04/16/2025
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