MEDICARE: TRISTAN EMILY BICKMAN MD

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	207V00000X	Obstetrics & Gynecology Physician	A016840	CA

General Provider Information

NPI Number	:	1245253210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISTAN EMILY BICKMAN MD

Provider Business Mailing Address
First Line	:	1245 16TH ST
Second Line	:	STE 312
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1239
Country	:	US
Telephone Number	:	310-453-1982
Fax Number	:	310-829-4942

Provider Business Practice Location Address
First Line	:	1245 16TH ST
Second Line	:	STE 312
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1239
Country	:	US
Telephone Number	:	310-453-1982
Fax Number	:	310-829-4942

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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