Provider Demographics
NPI:1285629444
Name:CARFRAE, BICK (MD)
Entity Type:Individual
Prefix:
First Name:BICK
Middle Name:
Last Name:CARFRAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BICK
Other - Middle Name:THI
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:411 LAUREL ST
Mailing Address - Street 2:SUITE 3170
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3017
Mailing Address - Country:US
Mailing Address - Phone:515-283-0463
Mailing Address - Fax:
Practice Address - Street 1:411 LAUREL ST
Practice Address - Street 2:SUITE 3170
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3017
Practice Address - Country:US
Practice Address - Phone:515-283-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-37939207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010275474Medicaid
VA010275466Medicaid
VA66704OtherCARENET
VAI42106Medicare UPIN
VA010275466Medicaid
VA012251A76Medicare PIN
VAP00347434Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER