Provider Demographics
NPI:1831295070
Name:SICKBERT, SCOTT F (MD, LLC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:F
Last Name:SICKBERT
Suffix:
Gender:M
Credentials:MD, LLC
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:F
Other - Last Name:SICKBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, LLC
Mailing Address - Street 1:5920 MCINTYRE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7445
Mailing Address - Country:US
Mailing Address - Phone:720-434-4876
Mailing Address - Fax:303-225-4246
Practice Address - Street 1:5920 MCINTYRE ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-7445
Practice Address - Country:US
Practice Address - Phone:720-434-4876
Practice Address - Fax:303-225-4246
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0025001207R00000X
CO25001207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68902573Medicaid
CO68902573Medicaid