Provider Demographics
NPI:1407899644
Name:CICCO-BROWN, CHRISTINE M (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:CICCO-BROWN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11715 RANGELAND PKWY
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9529
Mailing Address - Country:US
Mailing Address - Phone:941-538-0018
Mailing Address - Fax:941-538-0019
Practice Address - Street 1:11715 RANGELAND PKWY
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9529
Practice Address - Country:US
Practice Address - Phone:941-538-0018
Practice Address - Fax:941-538-0019
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10183207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00437132OtherRAILROAD MEDICARE
FL08918OtherBCBS
FL312566OtherAVMED
FL1059545OtherCAREPLUS
FL279328800Medicaid
FL7301096OtherAETNA
FL1059545OtherCAREPLUS
FL7301096OtherAETNA