MEDICARE: ANDREA BICKERTON M.D.

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	207Q00000X	Family Medicine Physician	2014020152	MO

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	:	1679988299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA BICKERTON M.D.

Provider Business Mailing Address
First Line	:	8855 IMMOKALEE RD UNIT 11
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-3928
Country	:	US
Telephone Number	:	239-302-3540
Fax Number	:	239-302-3535

Provider Business Practice Location Address
First Line	:	8855 IMMOKALEE RD UNIT 11
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-3928
Country	:	US
Telephone Number	:	239-302-3540
Fax Number	:	239-302-3535

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

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	09/04/2020

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