Individual
SUSANNA CICCOLARI MICALDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1001 N. MINNEAPOLIS ST, WICHITA, KS 67214-3127
(316) 293-2647
(855) 476-0305
Mailing address
1001 N MINNEAPOLIS ST, WICHITA, KS 67214-3127
(316) 293-2647
(855) 476-0305
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
04-41077
KS
2084P0800X
Psychiatry Physician
94-08402
KS
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
04-41077
KS
2084P0804X
Child & Adolescent Psychiatry Physician
94-08402
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30004664320001
—
KS
Enumeration date
06/27/2014
Last updated
06/21/2023
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