Healthcare Provider Details

I. General information

NPI: 1346250883
Provider Name (Legal Business Name): GEORGE S SICKLES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 DIXIE HWY SUITE 103
LOUISVILLE KY
40216-1702
US

IV. Provider business mailing address

5120 DIXIE HWY STE 103
LOUISVILLE KY
40216-1702
US

V. Phone/Fax

Practice location:
  • Phone: 502-587-1236
  • Fax: 502-587-0318
Mailing address:
  • Phone: 502-587-1236
  • Fax: 502-587-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number004746
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: