Individual
KELLY MCCABE BICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1755 N. FLORIDA AVENUE, LAKELAND, FL 33805-3109
(863) 904-6200
(863) 904-6280
Mailing address
PO BOX 95004, LAKELAND, FL 33804-5004
(863) 680-7000
(863) 680-7420
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME90648
FL
207N00000X
Dermatology Physician
Primary
ME90648
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000758500
—
FL
Enumeration date
03/17/2006
Last updated
06/01/2010
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