Provider Demographics
NPI:1982990289
Name:CICHON, PAULINE (DO)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:CICHON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17187 SCHAEFER HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-4132
Mailing Address - Country:US
Mailing Address - Phone:313-367-2767
Mailing Address - Fax:313-367-2818
Practice Address - Street 1:22972 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4408
Practice Address - Country:US
Practice Address - Phone:248-353-0079
Practice Address - Fax:248-809-6566
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020151208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI8662003Medicare PIN
ILRES000Medicare UPIN