Provider Demographics
NPI:1063892503
Name:SICARD, MITCHEL EH (CSA)
Entity type:Individual
Prefix:
First Name:MITCHEL
Middle Name:EH
Last Name:SICARD
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 WHITE OAK ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-4641
Mailing Address - Country:US
Mailing Address - Phone:240-543-5182
Mailing Address - Fax:
Practice Address - Street 1:2904 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-4641
Practice Address - Country:US
Practice Address - Phone:240-543-5182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-30
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical