| Doctor Name: | DR. ETHAN EDWIN BICKELHAUPT |
| NPI Number: | 1760427389 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 04-18225 |
| Business Practice Address: | 2200 Sw Gage Blvd Topeka, KS - 666220001 |
| Business Phone Number: | 7853503111 |
| Business Fax Number: | |
| Mailing Address: | 3315 Sw 15th St, TOPEKA |
| State: | KS |
| Postal Code: | 666042519 |
| Phone Number: | 7852733400 |
| Fax Number: | 7852732312 |
| NPI Enumeration Date: | 06/18/2006 |
| NPI Last Update Date: | 01/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084A0401X |
| License Number: | 04-18225 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KS |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |