MEDICARE: SCOT F. SICKBERT, M.D., LLC

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
1	207R00000X	Internal Medicine Physician	25001	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124216940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOT F. SICKBERT, M.D., LLC

Provider Business Mailing Address
First Line	:	325 PARKSIDE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3134
Country	:	US
Telephone Number	:	719-761-0397
Fax Number	:	719-473-7475

Provider Business Practice Location Address
First Line	:	325 PARKSIDE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3134
Country	:	US
Telephone Number	:	719-761-0397
Fax Number	:	719-473-7475

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. SCOT FRANCIS SICKBERT
Credential	:	M.D.
Telephone Number	:	719-761-0397

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	10/05/2007

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