Provider Demographics
NPI:1902817695
Name:DICECCO, RONALD JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOSEPH
Last Name:DICECCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 LIBERTY HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103
Mailing Address - Country:US
Mailing Address - Phone:734-665-1788
Mailing Address - Fax:
Practice Address - Street 1:5204 JACKSON RD
Practice Address - Street 2:SUITE C
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1866
Practice Address - Country:US
Practice Address - Phone:734-660-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055266207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHF24108Medicare UPIN