Provider Demographics
NPI:1679541338
Name:BICKNELL, DAVID L (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:BICKNELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 15TH STREET
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4563
Mailing Address - Country:US
Mailing Address - Phone:970-810-0900
Mailing Address - Fax:970-810-3795
Practice Address - Street 1:1800 15TH STREET
Practice Address - Street 2:SUITE 310
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4563
Practice Address - Country:US
Practice Address - Phone:970-810-0900
Practice Address - Fax:970-810-3795
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034.010639207R00000X, 207RC0000X
IL036107492207R00000X, 207RC0000X, 207RC0001X
OH34.010639207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH145400Medicare PIN
ILH22651Medicare UPIN