Provider Demographics
NPI:1508834847
Name:SICARD, MICHAEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:SICARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-294-3468
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-294-3468
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99-00680207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000000298835OtherUNISON HEALTH PLAN OF SC
NC31165OtherPARTNERS
NC891208WMedicaid
NC1208WOtherBCBS
NC17438OtherDOCTORS HEALTH PLAN
NC88418OtherMEDCOST
SC20096159OtherSELECT HEALTH OF SC
SCN00680Medicaid
NC276553OtherMAMSI
SCN00680Medicaid
NC891208WMedicaid
NC276553OtherMAMSI