Provider Demographics
NPI:1861020208
Name:PICKICH, MATTHEW BRENT
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRENT
Last Name:PICKICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15213 BIG RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2902
Mailing Address - Country:US
Mailing Address - Phone:228-243-1274
Mailing Address - Fax:
Practice Address - Street 1:1005 HARBORSIDE DRIVE UNIVERSITY HOSPITAL CLINICS (UHC)
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-2300
Practice Address - Country:US
Practice Address - Phone:409-772-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program