Provider Demographics
NPI:1669475224
Name:HICKS, SARA A (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8550 MARSHALL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1505
Mailing Address - Country:US
Mailing Address - Phone:913-451-4443
Mailing Address - Fax:913-495-3732
Practice Address - Street 1:8550 MARSHALL DR STE 200
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-9836
Practice Address - Country:US
Practice Address - Phone:913-495-2000
Practice Address - Fax:913-495-3715
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4P05207Q00000X
KS04-24572207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSH432921Medicare ID - Type UnspecifiedINDIVIDUAL MCR NUMBER
MOK67000038Medicare PIN
KSK67A00013Medicare PIN
KSE89011Medicare UPIN