Provider Demographics
NPI:1861462830
Name:BICKLE, RANDALL A (DO)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:A
Last Name:BICKLE
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 1:42931 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2277
Mailing Address - Country:US
Mailing Address - Phone:248-348-8700
Mailing Address - Fax:248-348-4914
Practice Address - Street 1:42931 7 MILE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2277
Practice Address - Country:US
Practice Address - Phone:248-348-8700
Practice Address - Fax:248-348-4914
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E33149Medicare UPIN