Healthcare Provider Details

I. General information

NPI: 1598405656
Provider Name (Legal Business Name): ANDREW BLAKE FICKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 08/19/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 MEDICAL PLAZA DR
NORTH CHARLESTON SC
29406-9104
US

IV. Provider business mailing address

9225 UNIVERSITY BLVD STE E2A
NORTH CHARLESTON SC
29406-9149
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-7000
  • Fax:
Mailing address:
  • Phone: 843-797-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number87963
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: