Healthcare Provider Details

I. General information

NPI: 1619910726
Provider Name (Legal Business Name): KYLE D. BICKEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CALIFORNIA ST SUITE 450
SAN FRANCISCO CA
94109-4586
US

IV. Provider business mailing address

1700 CALIFORNIA ST SUITE 450
SAN FRANCISCO CA
94109-4586
US

V. Phone/Fax

Practice location:
  • Phone: 415-751-4263
  • Fax: 415-359-1925
Mailing address:
  • Phone: 415-751-4263
  • Fax: 415-359-1925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberG65480
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberG65480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: