Provider Demographics
NPI:1437679529
Name:BICK, HEATHER ELLEN (DO)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELLEN
Last Name:BICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28248 W GREENMEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5162
Mailing Address - Country:US
Mailing Address - Phone:248-860-8975
Mailing Address - Fax:
Practice Address - Street 1:ONE GENESYS PARKWAY
Practice Address - Street 2:GENESYS REGIONAL MEDICAL CENTER
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-4843
Practice Address - Country:US
Practice Address - Phone:810-606-6372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315085299333600000X
MI5101023188207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No333600000XSuppliersPharmacy