Provider Demographics
NPI:1588649735
Name:RICO, IVETTE D (MD)
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:D
Last Name:RICO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5102 PAULSEN ST
Mailing Address - Street 2:BLDG 3
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4601
Mailing Address - Country:US
Mailing Address - Phone:912-644-4900
Mailing Address - Fax:912-691-0923
Practice Address - Street 1:5102 PAULSEN ST
Practice Address - Street 2:BLDG 3
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4601
Practice Address - Country:US
Practice Address - Phone:912-644-4900
Practice Address - Fax:912-691-0923
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-10-31
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Provider Licenses
StateLicense IDTaxonomies
GA037450208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000576391BMedicaid
GA000576391AMedicaid