Provider Demographics
NPI:1447204441
Name:CICCIO, AMY E (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:CICCIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 W 75TH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4001
Mailing Address - Country:US
Mailing Address - Phone:913-362-3210
Mailing Address - Fax:913-362-0407
Practice Address - Street 1:1147 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-5105
Practice Address - Country:US
Practice Address - Phone:816-322-6100
Practice Address - Fax:913-362-0407
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006019869207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO36749024OtherBCBS- CC LOCATION
MO36749014OtherBCBS- SL LOCATION
MO201389905Medicaid
MO201389905Medicaid
MO36749024OtherBCBS- CC LOCATION
MOI53458Medicare UPIN
MOP00323818Medicare PIN