Provider Demographics
NPI:1427059815
Name:STICKNEY, DONALD PHILIP (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:PHILIP
Last Name:STICKNEY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1198
Mailing Address - Country:US
Mailing Address - Phone:765-932-4111
Mailing Address - Fax:765-932-7505
Practice Address - Street 1:110 E 13TH ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-2126
Practice Address - Country:US
Practice Address - Phone:765-932-7063
Practice Address - Fax:765-932-7065
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01094893A207X00000X
OH35071425207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00381217OtherRR MEDICARE
OH2348954Medicaid
OHH18747Medicare UPIN
OHH198321Medicare PIN
OH4098871Medicare PIN