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General NPI Number Information
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NPI Number | 1760427389
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Entity Type | Individual
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Provider Name | ETHAN EDWIN BICKELHAUPT M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 2200 SW GAGE BLVD
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City | TOPEKA
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State | KS
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Zip | 66622-0001
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Country | US
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Telephone | 785-350-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 3315 SW 15TH ST
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City | TOPEKA
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State | KS
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Zip | 66604-2519
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Country | US
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Telephone | 785-273-3400
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Fax | 785-273-2312
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 04-18225
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 04-18225
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 04-18225
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 2084P2900X
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Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
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License Number | 04-18225
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License Number State | KS
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