Provider Demographics
NPI:1245223650
Name:SICKINGER, BARTON GLEN (DO FACC)
Entity Type:Individual
Prefix:
First Name:BARTON
Middle Name:GLEN
Last Name:SICKINGER
Suffix:
Gender:M
Credentials:DO FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N WYMORE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2859
Mailing Address - Country:US
Mailing Address - Phone:407-644-8668
Mailing Address - Fax:407-644-5637
Practice Address - Street 1:650 N WYMORE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2859
Practice Address - Country:US
Practice Address - Phone:407-644-8668
Practice Address - Fax:407-644-5637
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL050005006207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042383100Medicaid
2001321OtherAETNA
060031133OtherRR
82808Medicare ID - Type Unspecified
FL042383100Medicaid