Provider Demographics
NPI:1831115765
Name:BICKERS, DOUGLAS MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MARK
Last Name:BICKERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:800 HIGHLANDER POINT DR
Mailing Address - Street 2:STE 204
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9465
Mailing Address - Country:US
Mailing Address - Phone:812-542-4921
Mailing Address - Fax:812-949-5966
Practice Address - Street 1:1919 STATE STREET
Practice Address - Street 2:SUITE 248
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150
Practice Address - Country:US
Practice Address - Phone:812-945-7972
Practice Address - Fax:812-945-7969
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY23063207RC0000X
IN01032441A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64230634Medicaid
IN100115920AMedicaid
KY64230634Medicaid
INM400060422Medicare PIN