Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 4301101981 | MI |
NPI | 1053395889 |
---|---|
Provider Name | James Bicos |
First Address | Bingham Farms, MI 48025-4320 |
Second Address | Bingham Farms, MI 48025-4320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000373188 | BCBS (01) | IN |
200257130 | (05) | IN |
2555477 | UHC (01) | IN |
7453736 | AETNA (01) | IN |
I19619 | (02) | IN |