Basic Information
Provider Information | |||||||||
NPI: | 1669474839 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BICHSEL | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: | G | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 17 STANBERY AVE | ||||||||
Address2: |   | ||||||||
City: | COLUMBUS | ||||||||
State: | OH | ||||||||
PostalCode: | 432091463 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6142538203 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 745 W STATE ST | ||||||||
Address2: | STE 750 | ||||||||
City: | COLUMBUS | ||||||||
State: | OH | ||||||||
PostalCode: | 432221515 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6142242281 | ||||||||
FaxNumber: | 6142218869 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/01/2005 | ||||||||
LastUpdateDate: | 06/02/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 35-05-5118B | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
ID | Type | State | Issuer | Description | 2500042 | 01 | OH | UHC | OTHER | RAILROAD MEDICARE | 01 | OH | 060006985 | OTHER | 060006985 | 01 | OH | RAILROAD MEDICARE | OTHER | 0692479 | 05 | OH |   | MEDICAID | 1887949 | 01 | OH | CIGNA | OTHER | 289254 | 01 |   | BLACK LUNG | OTHER | 000000014684 | 01 |   | ANTHEM | OTHER | 1402 | 01 | OH | NATIONWIDE | OTHER |