Provider Demographics
NPI:1073810560
Name:BICKLE, KATHLEEN J (DPM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:BICKLE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-0730
Mailing Address - Country:US
Mailing Address - Phone:269-651-2320
Mailing Address - Fax:269-659-4704
Practice Address - Street 1:102 S LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1947
Practice Address - Country:US
Practice Address - Phone:269-651-2320
Practice Address - Fax:269-659-4704
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002385213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP45860Medicare PIN