Healthcare Provider Details

I. General information

NPI: 1518053511
Provider Name (Legal Business Name): MICAH S. BICKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 NE 6TH AVE
ESTACADA OR
97023-9312
US

IV. Provider business mailing address

4555 N WILLIAMS AVE
PORTLAND OR
97217-2955
US

V. Phone/Fax

Practice location:
  • Phone: 503-630-8550
  • Fax:
Mailing address:
  • Phone: 971-373-4165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0325344
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA175642
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: