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NPI Code Detail

MEDICARE: DR. CHRIS VANSICKLE M.D.

MEDICARE:  DR. CHRIS  VANSICKLE  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianME25500FL

General Provider Information

NPI Number : 1053329441
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRIS VANSICKLE M.D.
Provider Business Mailing Address
First Line : PO BOX 12427
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32317-2427
Country : US
Telephone Number : 850-297-0114
Fax Number : 850-297-2020
Provider Business Practice Location Address
First Line : 1636 N PLAZA DR
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-5323
Country : US
Telephone Number : 850-656-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 10/30/2013

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Directions to “ DR. CHRIS VANSICKLE M.D.” Practice Location

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