Healthcare Provider Details

I. General information

NPI: 1427059815
Provider Name (Legal Business Name): DONALD PHILIP STICKNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 13TH ST
RUSHVILLE IN
46173-2126
US

IV. Provider business mailing address

1300 N MAIN ST
RUSHVILLE IN
46173-1198
US

V. Phone/Fax

Practice location:
  • Phone: 765-932-7063
  • Fax: 765-932-7065
Mailing address:
  • Phone: 765-932-4111
  • Fax: 765-932-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01094893A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35071425
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: