Basic Information
| Provider Information | |||||||||
| NPI: | 1285194258 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PICKLESIMER | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 STONECREST RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400658143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0292810605 | ||||||||
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| Practice Location | |||||||||
| Address1: | 805 FARSON ST STE 115 | ||||||||
| Address2: | |||||||||
| City: | BELPRE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457141000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404233201 | ||||||||
| FaxNumber: | 7404233211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2019 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 56862 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.