Individual
DR. EVAN CICHELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
5800 RIDGE AVE, PHILADELPHIA, PA 19128-1737
(706) 338-4344
Mailing address
308 LODGE RD, PHILADELPHIA, PA 19128-4417
(706) 338-4344
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
SC006109
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029003330001
—
PA
01
—
455128844
GROUP TAX ID
PA
Enumeration date
09/01/2010
Last updated
12/30/2014
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