| Doctor Name: | MS. KIMBERLY SUE CICCERO |
| NPI Number: | 1083666036 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPM |
| License Number: | 36003436 |
| Business Practice Address: | 396 Portland Way North Galion, OH - 44833 |
| Business Phone Number: | 4194683668 |
| Business Fax Number: | 4194625037 |
| Mailing Address: | 3255 E Livingston Ave, Po Box 27940 COLUMBUS |
| State: | OH |
| Postal Code: | 432271923 |
| Phone Number: | 6142399444 |
| Fax Number: | 6142391080 |
| NPI Enumeration Date: | 05/17/2006 |
| NPI Last Update Date: | 09/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 36003436 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |