Susan K Bicknell, P.A.
Individual provider Active NPI Physician Assistant · Romulus, MI
NPI 1720100381 · NPPES record last updated Jun 30, 2009
Key facts
- NPI
- 1720100381
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601002574 (MI)
- Practice address
- 11700 Metro Airport Center Dr
Suite 104
Romulus, MI 48174-1456 - Phone
- (734) 955-7000
- Fax
- (734) 955-7006
- NPI assigned
- Apr 4, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601002574 | MI | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601002574 | MI | Yes |
Addresses
Primary practice location
11700 Metro Airport Center Dr
Suite 104
Romulus, MI 48174-1456
Mailing address
5080 Spectrum Dr
Suite 1200 West
Addison, TX 75001-4648
Phone (972) 364-8000
Other providers in Romulus, MI
- Kevin A. Barnes
- Sonia Baydoun
- Miracle Baynes
- Beautiful Mind Family Counseling Services, LLC
- Amy Benchich
- Bio-Medical Applications of Michigan, Inc.
- Tracy Renee Boatmon
- Boosted Care LLC
- Katrina P Bowens
- Linda Shawne Bowman
All providers in Romulus, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.