Gerald Angelo Ciccotelli Jr., RN
Registered Nurse, General Practice in Detroit, MI. Individual provider (NPI-1).
NPI number1689388282
StatusActive
Last updated in NPPESJan 9, 2023
Details
- NPI
- 1689388282
- Entity type
- Individual (NPI-1)
- Name
- Gerald Angelo Ciccotelli Jr.
- Credential
- RN
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 9, 2023
- Certification date
- Jan 9, 2023
- Last updated
- Jan 9, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163WG0000X | Registered Nurse, General Practice | 4704187346 | MI | Yes |
| 163WE0003X | Registered Nurse, Emergency | 4704187346 | MI |
Practice location
4646 John R StDetroit, MI 48201-1916
Phone 313-576-1000
Mailing address
4646 John R StDetroit, MI 48201-1916
Phone 313-576-1000
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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