Individual
ANTHONY DECICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 EDMUNDSON PL STE 306, COUNCIL BLUFFS, IA 51503-4620
(712) 396-7787
(712) 396-4115
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-5451
(402) 354-2155
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD461669
PA
207RI0011X
Interventional Cardiology Physician
Primary
0059581
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14024682
CAQH
—
Enumeration date
04/12/2011
Last updated
06/27/2022
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