Provider Demographics
NPI:1093770471
Name:CICHOCKI, GERALD ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ANTHONY
Last Name:CICHOCKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 S BONAVENTURE AVE
Mailing Address - Street 2:STE. #4
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2086
Mailing Address - Country:US
Mailing Address - Phone:719-846-2388
Mailing Address - Fax:
Practice Address - Street 1:328 S BONAVENTURE AVE
Practice Address - Street 2:STE. #4
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2086
Practice Address - Country:US
Practice Address - Phone:719-846-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43028208800000X
OHOH35-034809208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97350818Medicaid
CO97350818Medicaid
A77996Medicare UPIN