Provider Demographics
NPI:1164806048
Name:KICK, PRESTON JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:JAMES
Last Name:KICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 BRODHEAD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8617
Mailing Address - Country:US
Mailing Address - Phone:610-694-9090
Mailing Address - Fax:
Practice Address - Street 1:190 BRODHEAD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8617
Practice Address - Country:US
Practice Address - Phone:610-694-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT016306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine