Individual
DR. MICHAEL CHARLES CICHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
305 SUSAN DR, DWIGHT, IL 60420-1651
(815) 584-3588
Mailing address
103 S JOHN ST, DWIGHT, IL 60420-1413
(815) 584-3051
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-062435
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036062435
—
IL
01
—
053158073
BLUE CROSS BLUE SHIELD OF ILLINOIS
IL
Enumeration date
01/27/2006
Last updated
03/02/2022
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