Gerald Angelo Ciccotelli Jr., RN

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

4704187346 Issued in MI

Practice address

4646 John R St
Detroit, MI 48201-1916

Phone

(313) 576-1000

NPI assigned

Jan 9, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1689388282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 JOHN R ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011916",
            "telephone_number": "313-576-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 JOHN R ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011916",
            "telephone_number": "313-576-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CICCOTELLI",
        "first_name": "GERALD",
        "middle_name": "ANGELO",
        "name_suffix": "Jr.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-09",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "MI",
            "license": "4704187346",
            "primary": true
        },
        {
            "code": "163WE0003X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Emergency",
            "state": "MI",
            "license": "4704187346",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "23080",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://vaww.detroit.med.va.gov/",
            "affiliation": "N",
            "endpointDescription": "John D Dingell VA Medical Center",
            "address_1": "4646 John R St",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482011916",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://vaww.detroit.med.va.gov/",
            "affiliation": "N",
            "address_1": "4646 John R St",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482011916",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://vaww.detroit.med.va.gov/",
            "affiliation": "N",
            "address_1": "4646 John R St",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482011916",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://vaww.detroit.med.va.gov/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4646 John R St",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482011916",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jamie Lynne Ciaramitaro
• Andrea G Ciaravino, PA-C
• Marco Ciavaglia, DO
• Jaclyn Anne Cibasek, RN
• Elissa Cibulka, FNP
• Michelle A Cichon, M.S.
• Justin Eric Ciecko, CRNA
• Hannah Mary Cieglo
• Bernadette M Ciesinski, OTRL
• Yaroslav Ciko

• General Practice Registered Nurse in Detroit, MI
• Providers in Detroit, MI by specialty
• General Practice Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.