Provider Demographics
NPI:1043884463
Name:CICCATI, AUSTIN LOUIS (DO)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:LOUIS
Last Name:CICCATI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11420 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2237
Mailing Address - Country:US
Mailing Address - Phone:813-971-3136
Mailing Address - Fax:
Practice Address - Street 1:11420 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2237
Practice Address - Country:US
Practice Address - Phone:813-971-3136
Practice Address - Fax:813-910-3569
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS21141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine