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NPI Code Detail

MEDICARE: KENNETH BRIAN FICKLING MD

MEDICARE: KENNETH BRIAN FICKLING 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
1207L00000XAnesthesiology Physician198225NY

General Provider Information

NPI Number : 1508855347
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH BRIAN FICKLING MD
Provider Business Mailing Address
First Line : PO BOX 2005
Second Line :
City : EAST SYRACUSE
State : NY
Zip : 13057-4505
Country : US
Telephone Number : 315-449-0513
Fax Number : 315-445-2936
Provider Business Practice Location Address
First Line : 1425 PORTLAND AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14621-3011
Country : US
Telephone Number : 585-922-4159
Fax Number : 585-922-3731
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2005
Last Update Date : 01/23/2025

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