Basic Information
| Provider Information | |||||||||
| NPI: | 1285947671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BICKELL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 UNIVERSITY DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189401873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157105522 | ||||||||
| FaxNumber: | 2157105181 | ||||||||
| Practice Location | |||||||||
| Address1: | 1203 LANGHORNE NEWTOWN RD STE 225 | ||||||||
| Address2: | |||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157104490 | ||||||||
| FaxNumber: | 2157104491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2010 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | OS13226 | FL | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | OS016205 | PA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 1031183390001 | 05 | PA | MEDICAID | 5474716 | 01 | PA | AETNA | OTHER | 605568914 | 01 | PA | PA DEPT OF LABOR | OTHER | 015410800 | 05 | FL | MEDICAID | 8214725 | 01 | PA | CIGNA | OTHER | P01720209 | 01 | PA | RR MEDICARE | OTHER | 3406957 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 150L1 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 30268065 | 01 | PA | KEYSTONE FIRST | OTHER |