MEDICARE: ICARE CLINIC & MEDSPA 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	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003246181A	OTHER	GA	003246181A
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	G006535258	OTHER	GA	PTAN

General Provider Information

NPI Number	:	1275124166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICARE CLINIC & MEDSPA LLC

Provider Business Mailing Address
First Line	:	4580 MEMORIAL DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-1447
Country	:	US
Telephone Number	:	404-963-6861
Fax Number	:	404-963-6072

Provider Business Practice Location Address
First Line	:	4580 MEMORIAL DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-1447
Country	:	US
Telephone Number	:	770-856-8988
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SIKIRAT OROPO
Credential	:	DNP
Telephone Number	:	770-856-8988

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	02/07/2024

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Directions to “ICARE CLINIC & MEDSPA LLC ” Practice Location

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