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Individual

MICHAEL P. TRICASO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
200 W LORAIN ST, OBERLIN, OH 44074-1026
(440) 775-1211
(440) 775-9118
Mailing address
PO BOX 65274, CHARLOTTE, NC 28265-0274
(800) 377-8721
(304) 523-2241

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34-00-7428-T
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2196798
OH
01
5619197341B87
BLUECROSS BLUESHIELD
OH
Enumeration date
01/25/2006
Last updated
09/14/2007
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