Healthcare Provider Details

I. General information

NPI: 1730332701
Provider Name (Legal Business Name): MELISSA BICKETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 05/15/2023
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 BELPAR ST NW
CANTON OH
44718-3603
US

IV. Provider business mailing address

4760 BELPAR ST NW
CANTON OH
44718-3603
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-9200
  • Fax: 330-492-5454
Mailing address:
  • Phone: 330-492-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR1914
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberP6588
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number122609
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: