Provider Demographics
NPI:1295000255
Name:BICK, ILSA (MD)
Entity Type:Individual
Prefix:
First Name:ILSA
Middle Name:
Last Name:BICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:KOHLER
Mailing Address - State:WI
Mailing Address - Zip Code:53044-1306
Mailing Address - Country:US
Mailing Address - Phone:920-254-3572
Mailing Address - Fax:
Practice Address - Street 1:1099 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:KOHLER
Practice Address - State:WI
Practice Address - Zip Code:53044-1306
Practice Address - Country:US
Practice Address - Phone:920-254-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43358-202084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry