Provider Demographics
NPI:1316904865
Name:BICAK, AJDAHAN DENIZ (MD)
Entity type:Individual
Prefix:DR
First Name:AJDAHAN
Middle Name:DENIZ
Last Name:BICAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:A.
Other - Middle Name:D
Other - Last Name:BICAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:301 SW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7173
Mailing Address - Country:US
Mailing Address - Phone:479-273-2228
Mailing Address - Fax:479-273-3338
Practice Address - Street 1:301 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7173
Practice Address - Country:US
Practice Address - Phone:479-273-2228
Practice Address - Fax:479-273-3338
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARG57434Medicare UPIN
AR5L111Medicare ID - Type Unspecified