Individual
JAMES R CICCHIELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7926 PRESTON HWY, STE 210, LOUISVILLE, KY 40219-3848
(502) 966-8675
(502) 966-8836
Mailing address
PO BOX 950202, LOUISVILLE, KY 40295-0202
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
26217
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000364343
ANTHEM - NMA
—
01
—
000000720334
ANTHEM - ICC
KY
01
—
0000023025F
HUMANA / NMA
—
01
—
062447
SIHO - NMA
—
01
—
0724045
CIGNA / NMA
—
01
—
1193582
CHA / NMA
—
01
—
2448315000
PAD - NMA
—
01
—
50007142
PASSPORT - NMA
—
05
—
64262173
—
KY
01
—
P00266880
RRMCR - NMA
KY
Enumeration date
04/19/2006
Last updated
11/10/2014
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