Provider Demographics
NPI:1053497362
Name:HICKS, SCOTT C (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:HICKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:W129N7055 NORTHFIELD DR
Mailing Address - Street 2:ORTHOPAEDIC SURGERY
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-0538
Mailing Address - Country:US
Mailing Address - Phone:262-253-5400
Mailing Address - Fax:262-253-3399
Practice Address - Street 1:W129N7055 NORTHFIELD DR
Practice Address - Street 2:ORTHOPAEDIC SURGERY
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-0538
Practice Address - Country:US
Practice Address - Phone:262-253-5400
Practice Address - Fax:262-253-3399
Is Sole Proprietor?:No
Enumeration Date:2006-10-29
Last Update Date:2015-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI49679207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1053497362Medicaid
WI1053497362Medicaid