Individual
MARKE LEE BICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8100 W 78TH ST STE 230, EDINA, MN 55439-2570
(952) 946-9777
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
36001998A
IN
363A00000X
Physician Assistant
10002200A
IN
363A00000X
Physician Assistant
Primary
14496
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001075336
ANTHEM PROVIDER NUMBER
IN
Enumeration date
11/04/2016
Last updated
05/31/2023
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