# SICKBAY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104525898
- **Authorized official:** EZRA KOCH (MEMBER)
- **Authorized official phone:** (701) 426-4291

## Contact information

- **Practice address:** 4108 39TH AVE NW, MANDAN, ND 58554-1253
- **Practice address phone:** (701) 426-4291
- **Mailing address:** 4108 39TH AVE NW, MANDAN, ND 58554-1253

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/01/2023
- **Last updated:** 03/01/2023