Provider Demographics
NPI:1124047493
Name:TICARIC, STEPHEN T (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:T
Last Name:TICARIC
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 1:3443 DICKERSON PIKE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2519
Mailing Address - Country:US
Mailing Address - Phone:615-868-0352
Mailing Address - Fax:615-868-4076
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SUITE 430
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:615-868-0352
Practice Address - Fax:615-868-4076
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD09568207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3189831Medicaid
TNB04400Medicare UPIN
TN3189831Medicare ID - Type Unspecified