Provider Demographics
NPI:1558476457
Name:HICKERT, MAUREEN COLETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:COLETTE
Last Name:HICKERT
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 1:3628 VICTORIA LANE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208
Mailing Address - Country:US
Mailing Address - Phone:513-207-7311
Mailing Address - Fax:513-559-3848
Practice Address - Street 1:2621 VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1754
Practice Address - Country:US
Practice Address - Phone:513-861-6688
Practice Address - Fax:513-559-3848
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065302H2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0932932Medicaid
F03959Medicare UPIN
H0744915Medicare ID - Type Unspecified