Individual
MICHAEL CHARLES TRICOCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
412 N MONROE ST, WILLIAMSPORT, IN 47993-1049
(765) 762-4050
Mailing address
2800 W LIBERTY CHURCH RD, COVINGTON, IN 47932-8038
(312) 399-4935
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01071498A
IN
207Q00000X
Family Medicine Physician
01071498A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201083110
—
IN
Enumeration date
06/23/2009
Last updated
05/11/2020
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