Provider Demographics
NPI:1023250529
Name:BICKLEY, EERICCA MICHELLE (DO)
Entity type:Individual
Prefix:MRS
First Name:EERICCA
Middle Name:MICHELLE
Last Name:BICKLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:EERICCA
Other - Middle Name:MICHELLE
Other - Last Name:CLEGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 748860
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8860
Mailing Address - Country:US
Mailing Address - Phone:480-644-1001
Mailing Address - Fax:480-644-1002
Practice Address - Street 1:4824 E BASELINE RD STE 129
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4679
Practice Address - Country:US
Practice Address - Phone:480-644-1001
Practice Address - Fax:480-644-1002
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006152207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ817676Medicaid
AZZ159113Medicare UPIN