Individual
DR. DAVID BRUCE TICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
216 GREEN BAY RD STE 109, THIENSVILLE, WI 53092
(262) 241-5414
(262) 241-5425
Mailing address
216 GREEN BAY RD STE 109, THIENSVILLE, WI 53092-1625
(262) 241-5414
(262) 672-4046
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34022
WI
207SG0201X
Clinical Genetics (M.D.) Physician
34022
WI
208000000X
Pediatrics Physician
34022
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050577505014
BLUE CROSS/BLUE SHIELD
WI
01
—
110174900
RAILROAD MEDICARE
WI
05
—
31891200
—
WI
01
—
33540257
CHAMPUS
WI
Enumeration date
03/10/2006
Last updated
05/17/2018
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