MEDICARE: DR. DANIEL THOMAS SICKING 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	207R00000X	Internal Medicine Physician	9300396	NC

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	:	1346218385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL THOMAS SICKING MD

Provider Business Mailing Address
First Line	:	2109 S MAIN ST
Second Line	:	SUITE 100
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-5099
Country	:	US
Telephone Number	:	919-562-4441
Fax Number	:	919-562-5779

Provider Business Practice Location Address
First Line	:	2109 S MAIN ST
Second Line	:	SUITE 100
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-5099
Country	:	US
Telephone Number	:	919-562-4441
Fax Number	:	919-562-5779

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	08/14/2012

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