Provider Demographics
NPI:1083628721
Name:MICUCCI, FRANK (MPA-C)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:MICUCCI
Suffix:
Gender:M
Credentials:MPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 S ROOSEVELT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-1668
Mailing Address - Country:US
Mailing Address - Phone:319-768-4320
Mailing Address - Fax:
Practice Address - Street 1:624 S ROOSEVELT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-1668
Practice Address - Country:US
Practice Address - Phone:319-768-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA17518OtherWELLMARK BLUE CROSS BLUE
IA4554OtherMIDLANDS
IA970014324OtherRR MEDICARE
IA168951OtherRH MEDICARE
IA168951OtherRH MEDICARE
IAS91882Medicare UPIN