Healthcare Provider Details

I. General information

NPI: 1013446285
Provider Name (Legal Business Name): TRENTON BICKEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 CLAY EDWARDS DRIVE, SUITE 520/570
NORTH KANSAS CITY MO
64116
US

IV. Provider business mailing address

2800 CLAY EDWARDS DRIVE, CENTRAL VERIFICATION OFFICE AND PAYOR ENROLLMENT
NORTH KANSAS CITY MO
64116
US

V. Phone/Fax

Practice location:
  • Phone: 816-221-6750
  • Fax: 816-221-7280
Mailing address:
  • Phone: 816-691-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE-16508
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2021039059
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017018407
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2020019589
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: