Provider Demographics
NPI:1467689844
Name:BICKING, GRIFFIN KEITH (DO)
Entity Type:Individual
Prefix:DR
First Name:GRIFFIN
Middle Name:KEITH
Last Name:BICKING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:502-489-5700
Practice Address - Street 1:2603 KENTUCKY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3814
Practice Address - Country:US
Practice Address - Phone:270-415-4802
Practice Address - Fax:270-415-4835
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0141702086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100212750Medicaid
KY7100212750Medicaid