Provider Demographics
NPI:1104805878
Name:BICA, THOMAS DENNIS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DENNIS
Last Name:BICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 E WASHINGTON ST
Mailing Address - Street 2:SUITE 6-C
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3332
Mailing Address - Country:US
Mailing Address - Phone:330-722-3083
Mailing Address - Fax:330-725-5043
Practice Address - Street 1:970 E WASHINGTON ST
Practice Address - Street 2:SUITE 6-C
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3332
Practice Address - Country:US
Practice Address - Phone:330-722-3083
Practice Address - Fax:330-725-5043
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH39938246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0431063Medicaid
OH0431063Medicaid
OHA78897Medicare UPIN
OH0465691Medicare ID - Type Unspecified