Provider Demographics
NPI:1639192958
Name:BRICKEL, DAVID R II (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:BRICKEL
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1060 S VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9631
Mailing Address - Country:US
Mailing Address - Phone:989-269-6651
Mailing Address - Fax:989-269-2171
Practice Address - Street 1:1060 S VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9631
Practice Address - Country:US
Practice Address - Phone:989-269-6651
Practice Address - Fax:989-269-2171
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIDB039784208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4723567Medicaid
MIB43308Medicare UPIN
MIOC26008100Medicare ID - Type Unspecified