Individual ProviderMichelle RicciPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address10625 W North Ave Ste 102, Wauwatosa, WI 53226-2315(414) 877-5350(269) 615-3474PECOS EnrollmentBased on the most recent information from CMS, provider Michelle Ricci is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1598280695Provider TypeIndividualFull NameRicci, MichelleCredentialPA-CGenderFemaleSole ProprietorNoEnumeration Date8/9/2017Last Updated4/10/2019Contact InformationPractice LocationPractice Address10625 W North Ave Ste 102, Wauwatosa, WI 53226-2315Phone(414) 877-5350FaxUnlisted FaxMailing LocationMailing Address2454 N 89th St, Wauwatosa, WI 53226-1804Phone(269) 615-3474FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense4141-23WisconsinProvider IdentifiersIDDescriptionIssuerID1598280695DescriptionMedicaidIssuerUnlistedWisconsin