Michael Charles Lick

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

4300 Market Pte Dr Ste 100
Bloomington, MN 55435-5435

Phone

(457) 495-2767

NPI assigned

Jun 19, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Emergency Physicians Professional Association

  dba Emergency Physicians, P.A.

  • Emergency Medicine Physician
  • Bloomington, MN
  • NPI 1801871934
  Medicare reassignment
• Emergency Physicians Professional Association

  • Urgent Care Clinic/Center
  • Eagan, MN
  • NPI 1407102882
  NPD
• Emergency Physicians Professional Association

  dba The Urgency Room - Golden Valley

  • Urgent Care Clinic/Center
  • Golden Valley, MN
  • NPI 1750188488
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1023793932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W 5TH ST # 2",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558062729",
            "telephone_number": "612-708-8024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 MARKET PTE DR STE 100",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554355435",
            "telephone_number": "457-495-2767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICK",
        "first_name": "MICHAEL",
        "middle_name": "CHARLES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-19",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriella Lewis
• LHCG Xlviii, LLC (Minnesota Home Health)
• Vivian Li, DO
• Chase Liaboe
• Rachel Dawn Libengood
• Heather J Lidholm, MA LMFT
• Isabell Liebzeit
• Lindsay Liekis
• Kadence Alyssa Lieser
• Life Care Retirement Communities Inc (Friendship Village of Bloomington-Highwood Park)

• Physician Assistant in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.