Healthcare Provider Details

I. General information

NPI: 1790168250
Provider Name (Legal Business Name): SICARD SURGICAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5257 BUCKEYSTOWN PIKE #244
FREDERICK MD
21704-7535
US

IV. Provider business mailing address

2904 WHITE OAK ST
HIGHLANDS RANCH CO
80129-4641
US

V. Phone/Fax

Practice location:
  • Phone: 240-543-5182
  • Fax:
Mailing address:
  • Phone: 240-543-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name: MITCHEL E SICARD
Title or Position: PRESIDENT/CSA
Credential: CSA
Phone: 240-543-5182