Provider Demographics
NPI:1770032989
Name:CICCHINI, MIRAH
Entity type:Individual
Prefix:MRS
First Name:MIRAH
Middle Name:
Last Name:CICCHINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11075 W GATES ST
Mailing Address - Street 2:
Mailing Address - City:BRUCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48065-4375
Mailing Address - Country:US
Mailing Address - Phone:813-534-3577
Mailing Address - Fax:
Practice Address - Street 1:11075 W GATES ST
Practice Address - Street 2:
Practice Address - City:BRUCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48065-4375
Practice Address - Country:US
Practice Address - Phone:813-534-3577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other