Provider Demographics
NPI:1205884889
Name:CICCARELLI, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:CICCARELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26250
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66225-6250
Mailing Address - Country:US
Mailing Address - Phone:913-322-2700
Mailing Address - Fax:913-322-7890
Practice Address - Street 1:23351 PRAIRIE STAR PKWY STE 275
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-6201
Practice Address - Country:US
Practice Address - Phone:913-322-2700
Practice Address - Fax:913-322-2700
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-30147207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H60664Medicare UPIN