MEDICARE: MS. ELIZABETH RENEE ICKES PA-C

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	363A00000X	Physician Assistant	50002084	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00863389	OTHER	OH	RAILROAD MEDICARE
2	P00639340	OTHER	OH	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1245203421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH RENEE ICKES PA-C

Provider Business Mailing Address
First Line	:	3401 WELLNESS WAY STE A3
Second Line	:
City	:	FINDLAY
State	:	OH
Zip	:	45840-9547
Country	:	US
Telephone Number	:	419-420-7304
Fax Number	:	419-420-7317

Provider Business Practice Location Address
First Line	:	3401 WELLNESS WAY STE A3
Second Line	:
City	:	FINDLAY
State	:	OH
Zip	:	45840-9547
Country	:	US
Telephone Number	:	419-420-7304
Fax Number	:	419-420-7317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	08/13/2025

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