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General NPI Number Information
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NPI Number | 1831160563
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Entity Type | Organization
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Legal Business Name | RANDALL A. BICKLE, DO., PC
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 42000 6 MILE RD SUITE 201
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City | NORTHVILLE
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State | MI
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Zip | 48168-4336
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Country | US
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Telephone | 248-735-9100
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Fax | 248-735-9101
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Provider Business Mailing Address
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Address Line | 42000 6 MILE RD SUITE 201
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City | NORTHVILLE
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State | MI
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Zip | 48168-4336
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Country | US
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Telephone | 248-735-9100
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Fax | 248-735-9101
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Authorized Official
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Title or Position | PRESIDENT
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Name | RANDALL A. BICKLE
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Credential | D.O.
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Telephone | 734-266-2780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | MI
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