Provider Demographics
NPI:1184689051
Name:CIANCIO, GAETANO (MD, MBA)
Entity Type:Individual
Prefix:
First Name:GAETANO
Middle Name:
Last Name:CIANCIO
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 NW 9TH AVE FL 3
Mailing Address - Street 2:HIGHLAND PROFESSIONAL BLDG.
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1124
Mailing Address - Country:US
Mailing Address - Phone:305-355-5111
Mailing Address - Fax:305-355-5234
Practice Address - Street 1:1801 NW 9TH AVE FL 3
Practice Address - Street 2:HIGHLAND PROFESSIONAL BLDG.
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1124
Practice Address - Country:US
Practice Address - Phone:305-355-5111
Practice Address - Fax:305-355-5234
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52984204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3776093-00Medicaid
FLG07279Medicare UPIN
FL27080Medicare ID - Type Unspecified