Provider Demographics
NPI:1518053511
Name:BICKER, MICAH S (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICAH
Middle Name:S
Last Name:BICKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 N WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2955
Mailing Address - Country:US
Mailing Address - Phone:971-373-4165
Mailing Address - Fax:
Practice Address - Street 1:535 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-9312
Practice Address - Country:US
Practice Address - Phone:503-630-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA207Q00000X
KS0325344363A00000X
ORPA175642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR188820OtherMEDICARE PTAN
KS100427720BMedicaid
WA1518053511Medicaid
OR500710332Medicaid