Individual
KEVIN MICHAEL FICKENSCHER SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3499 NW BRAID DRIVE, BEND, OR 97701-8682
(415) 307-7358
(415) 223-9383
Mailing address
7710 WOODMONT AVENUE, SUITE 211, BETHESDA, MD 20814
(415) 450-1515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G84904
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G84904
CALIFORNIA STATE MEDICAL BOARD
CA
Enumeration date
10/29/2010
Last updated
03/07/2023
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