Provider Demographics
NPI:1376588988
Name:HICKS, CINDY LAURIE (DPM)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:LAURIE
Last Name:HICKS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-128 AIEA HEIGHTS DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3932
Mailing Address - Country:US
Mailing Address - Phone:808-487-6903
Mailing Address - Fax:808-487-6906
Practice Address - Street 1:99-128 AIEA HEIGHTS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3932
Practice Address - Country:US
Practice Address - Phone:808-487-6903
Practice Address - Fax:808-487-6906
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO171213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000251579OtherHMSA
HI565898Medicaid
HI5779619OtherUHA
HI521671OtherHMN
HIH100283Medicare PIN
HI565898Medicaid