Provider Demographics
NPI:1841392354
Name:SICKELS, MALCOLM (MD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:
Last Name:SICKELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 LITTLE LAKE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6218
Mailing Address - Country:US
Mailing Address - Phone:734-332-9936
Mailing Address - Fax:734-864-0018
Practice Address - Street 1:210 LITTLE LAKE DR STE 10
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6218
Practice Address - Country:US
Practice Address - Phone:734-332-9936
Practice Address - Fax:734-864-0018
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I25137Medicare UPIN