Provider Demographics
NPI:1548201569
Name:CICIO, WILLIAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:CICIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTENTION PATIENT ACCOUNTING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6827
Mailing Address - Fax:843-234-6990
Practice Address - Street 1:2376 CYPRESS CIR STE 102
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8964
Practice Address - Country:US
Practice Address - Phone:843-347-8953
Practice Address - Fax:843-347-0226
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 88048207RC0000X
PAMD453708207RC0000X
SC83204207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272405700Medicaid
FLF99329Medicare UPIN
FL272405700Medicaid