Basic Information
| Provider Information | |||||||||
| NPI: | 1639174097 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DICIOCCIO | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 W EXCHANGE ST | ||||||||
| Address2: | STE 220 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443021704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303446401 | ||||||||
| FaxNumber: | 3303441714 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 WABASH AVE | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443072433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303446000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2005 | ||||||||
| LastUpdateDate: | 04/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35-05-1073 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 000000024061 | 01 | OH | ANTHEM PIN# | OTHER | 0698651 | 05 | OH | MEDICAID | 050050525 | 01 | OH | TRAVELERS PIN# | OTHER | 20-00770 | 01 | OH | OH UNHC PIN# | OTHER |