Healthcare Provider Details

I. General information

NPI: 1912221623
Provider Name (Legal Business Name): SCOTT GRAHAM BICKEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E CHESTNUT ST
LOUISVILLE KY
40202-1713
US

IV. Provider business mailing address

PO BOX 776879
CHICAGO IL
60677-6789
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-4940
  • Fax: 502-588-7712
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46010
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number46010
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: