Basic Information
| Provider Information | |||||||||
| NPI: | 1972503639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BICKEL | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1370 | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423021370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706868500 | ||||||||
| FaxNumber: | 2706855467 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 TRIPLETT ST | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423033163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706868500 | ||||||||
| FaxNumber: | 2706855467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 04/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 27589 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 65922197 | 05 | KY | MEDICAID |