Provider Demographics
NPI:1487657185
Name:HICKS, GEORGE WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WILLIAM
Last Name:HICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 N SHADELAND AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2095
Mailing Address - Country:US
Mailing Address - Phone:317-842-4901
Mailing Address - Fax:317-842-4393
Practice Address - Street 1:7440 N SHADELAND AVE
Practice Address - Street 2:STE 150
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2095
Practice Address - Country:US
Practice Address - Phone:317-842-4901
Practice Address - Fax:317-842-4393
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026461A207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091198OtherANTHEM PROVIDER NUMBER
IN211177OtherHEALTHLINK PROVIDER NUMBE
IN1028041OtherCIGNA PROVIDER NUMBER
IN4004243OtherAETNA PROVIDER NUMBER
C24292Medicare UPIN
IN4004243OtherAETNA PROVIDER NUMBER