Provider Demographics
NPI:1912948126
Name:BICKLEY, MARK L (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:BICKLEY
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Gender:M
Credentials:DO
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Mailing Address - Street 1:2101 KIMBALL AVE
Mailing Address - Street 2:LL14
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5063
Mailing Address - Country:US
Mailing Address - Phone:319-272-1590
Mailing Address - Fax:319-272-1535
Practice Address - Street 1:2710 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 210
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5619
Practice Address - Country:US
Practice Address - Phone:319-272-5000
Practice Address - Fax:319-272-5282
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-13
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Provider Licenses
StateLicense IDTaxonomies
IA01878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2195693Medicaid
IA15654Medicare PIN
IAA02012Medicare UPIN