Provider Demographics
NPI:1497751259
Name:RICKMAN, MICHAEL ZANE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ZANE
Last Name:RICKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3880
Mailing Address - Country:US
Mailing Address - Phone:580-237-0322
Mailing Address - Fax:580-233-0402
Practice Address - Street 1:721 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3880
Practice Address - Country:US
Practice Address - Phone:580-237-0322
Practice Address - Fax:580-233-0402
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100490AMedicaid
730776935003OtherBLUE CROSS
P00061497OtherRAILROAD MEDICARE PTAN
P00061497OtherRAILROAD MEDICARE PTAN
OK730776935OtherEIN
OK730776935OtherEIN