MICAH SHIGENORI ITICOVICI MD
NPI 1114667011
Student in an Organized Health Care Education/Training Program in Indianapolis, IN

Q: What is Micah Iticovici's NPI number?

The NPI number for Micah Iticovici is 1114667011. It was assigned to this individual provider in the NPPES registry on March 30, 2022.

Q: What is Micah Iticovici's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Micah Iticovici was last updated on April 5, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 30, 2022PECOS Enrolled

355 W 16TH ST STE 2364, INDIANAPOLIS, IN 46202(317) 963-7288 Get Directions Write a Review

NPPES record last updated: April 5, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Micah Shigenori Iticovici Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MICAH SHIGENORI ITICOVICI MD (NPI 1114667011) is an individual student in an organized health care education/training program in Indianapolis, Indiana and active in the NPI registry since March 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1114667011

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameMICAH SHIGENORI ITICOVICICredential: MD

Location Address355 W 16TH ST STE 2364Indianapolis, IN 46202-2279

Mailing Address355 W 16th St Ste 2364Indianapolis, IN 46202-2279 · (317) 963-7288

Phone(317) 963-7288

Sole ProprietorNo

Enumeration DateMarch 30, 2022

Last NPPES UpdateApril 5, 2022

NPPES CertifiedApril 5, 2022

✔ NPI 1114667011 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

355 W 16TH ST STE 2364, Indianapolis, IN 46202

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Micah Shigenori Iticovici Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. AMANDA ROSEMARIE KAMINSKI

Student in an Organized Health Care Education/Training Program