Provider Demographics
NPI:1588695704
Name:SICKELS, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:SICKELS
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 1:111 E WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4815
Mailing Address - Country:US
Mailing Address - Phone:414-290-6720
Mailing Address - Fax:414-290-6755
Practice Address - Street 1:111 E WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4815
Practice Address - Country:US
Practice Address - Phone:414-290-6720
Practice Address - Fax:414-290-6755
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37766-020207P00000X
WI37766-20207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI930044456OtherMEDICARE RAILROAD
WIP00233036OtherMEDICARE RAILROAD
WI32229000Medicaid
WIP00024348OtherMEDICARE RAILROAD
WIP00257228OtherMEDICARE RAILROAD
WIP00024348OtherMEDICARE RAILROAD
WI930044456OtherMEDICARE RAILROAD
WI0005-10006Medicare ID - Type Unspecified
WI0001-60045Medicare ID - Type Unspecified
WI32229000Medicaid
WI0006-71116Medicare ID - Type Unspecified
WI0006-45034Medicare ID - Type Unspecified