Provider Demographics
NPI:1932312840
Name:CICHOWICZ, IVAN EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:EDUARDO
Last Name:CICHOWICZ
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 1:2201 NW CORPORATE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7337
Mailing Address - Country:US
Mailing Address - Phone:561-499-6932
Mailing Address - Fax:561-235-5172
Practice Address - Street 1:2201 NW CORPORATE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7337
Practice Address - Country:US
Practice Address - Phone:561-499-6932
Practice Address - Fax:561-235-5172
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1152412084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHT834ZMedicare PIN