Provider Demographics
NPI:1003822198
Name:HICKS, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 DTC PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2709
Mailing Address - Country:US
Mailing Address - Phone:303-745-0000
Mailing Address - Fax:303-708-1834
Practice Address - Street 1:5200 DTC PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2709
Practice Address - Country:US
Practice Address - Phone:303-745-0000
Practice Address - Fax:303-708-1834
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45326207R00000X, 208M00000X
IL036112109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7215059OtherBCBS PPO
IL0361121092Medicaid
IL105682OtherHEALTH ALLIANCE
IL623665OtherHEALTHLINK
ILIL01V7OtherJOHN DEERE
ILP00281865OtherRAILROAD MEDICARE
CO46379576Medicaid
IL623665OtherHEALTHLINK
COCO304802Medicare PIN