Provider Demographics
NPI:1164425013
Name:SICELOFF, THURMOND ERIC (DPM)
Entity Type:Individual
Prefix:DR
First Name:THURMOND
Middle Name:ERIC
Last Name:SICELOFF
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 1:6341 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9379
Mailing Address - Country:US
Mailing Address - Phone:336-766-8400
Mailing Address - Fax:336-766-8486
Practice Address - Street 1:6341 COOK AVE
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012
Practice Address - Country:US
Practice Address - Phone:336-766-4800
Practice Address - Fax:336-766-8486
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC388213ES0103X, 213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01909015OtherRAILROAD MEDICARE
NC7908019Medicaid
NCNCH360B699OtherMEDICARE
NC1164425013Medicaid