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1972899862

NPI Code Detail

MEDICARE: JENNIFER BICKHAUS MD

MEDICARE: JENNIFER BICKHAUS 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	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	2018012016	MO
2	207V00000X	Obstetrics & Gynecology Physician	2018012016	MO

General Provider Information

NPI Number	:	1972899862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BICKHAUS MD

Provider Business Mailing Address
First Line	:	1031 BELLEVUE AVE STE 200
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1856
Country	:	US
Telephone Number	:	314-977-7455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1031 BELLEVUE AVE STE 200
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1856
Country	:	US
Telephone Number	:	314-977-7455
Fax Number	:

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

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	02/10/2021

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Directions to “ JENNIFER BICKHAUS MD” Practice Location

Language	Start Address	Practice Location

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