Provider Demographics
NPI:1568462133
Name:CAICCO, GENE (DPM)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:
Last Name:CAICCO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 E 12 MILE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3400
Mailing Address - Country:US
Mailing Address - Phone:586-573-7470
Mailing Address - Fax:586-573-0850
Practice Address - Street 1:11900 E 12 MILE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3400
Practice Address - Country:US
Practice Address - Phone:586-573-7470
Practice Address - Fax:586-573-0850
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2011-10-27
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
MIGC001745213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383523897OtherPPOM
MI5901001745OtherBCBSM
MI4246887Medicaid
MI383523897OtherST JOHN SMART PLAN
MI383523897OtherUNITED HEALTH CARE
MI383523897OtherST JOHN SMART PLAN
MIU61949Medicare UPIN
MI4246887Medicaid