1609958651 NPI number — BRIAN SICK MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609958651 NPI number — BRIAN SICK MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SICK

Provider First Name:

BRIAN

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1609958651

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/12/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

720 WASHINGTON AVE SE

Provider Second Line Business Mailing Address:

UNIVERSITY OF MINNESOTA PHYSICIANS

Provider Business Mailing Address City Name:

MINNEAPOLIS

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55414-2924

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-884-0649

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

516 DELAWARE STREET SE

Provider Second Line Business Practice Location Address:

PWB THIRD FLOOR CLINIC 3A

Provider Business Practice Location Address City Name:

MINNEAPOLIS

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55455

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

612-624-9499

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

10/19/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  44393 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 208000000X , with the licence number: 44393 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 132152 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 612R5SI . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 04-00123 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 088457000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 0074205 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 1030261 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 04-07057 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1576345 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP38101 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".