Provider Demographics
NPI:1861563389
Name:CICHANOWSKI, MICHAEL JAMES
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:CICHANOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WINGHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8058
Mailing Address - Country:US
Mailing Address - Phone:407-273-4235
Mailing Address - Fax:407-273-4235
Practice Address - Street 1:100 WINGHURST BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8058
Practice Address - Country:US
Practice Address - Phone:407-273-4235
Practice Address - Fax:407-273-4235
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3501-0006722332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01763868Medicaid
MS0440758Medicaid
NJ5445108Medicaid
NC7702075Medicaid
TXDME00C150Medicaid
SCDME1115Medicaid
TXDME00C150Medicaid