Provider Demographics
NPI:1073105722
Name:HICKHAM ENT LLC
Entity Type:Organization
Organization Name:HICKHAM ENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HICKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-938-1868
Mailing Address - Street 1:4315 HOUMA BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2941
Mailing Address - Country:US
Mailing Address - Phone:504-889-5335
Mailing Address - Fax:504-889-5451
Practice Address - Street 1:501 RUE DE SANTE
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5400
Practice Address - Country:US
Practice Address - Phone:985-359-4600
Practice Address - Fax:985-359-4604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty