Provider Demographics
NPI:1093710527
Name:BICAK, NIKOLA (DPM)
Entity Type:Individual
Prefix:
First Name:NIKOLA
Middle Name:
Last Name:BICAK
Suffix:
Gender:M
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 796
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-0796
Mailing Address - Country:US
Mailing Address - Phone:304-372-3788
Mailing Address - Fax:
Practice Address - Street 1:1837 RIPLEY RD
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-5113
Practice Address - Country:US
Practice Address - Phone:304-372-3788
Practice Address - Fax:304-372-1513
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV307213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0099957000Medicaid
WV0099957000Medicaid
WV4344300001Medicare NSC
0791281Medicare PIN