Provider Demographics
NPI:1689604282
Name:HICKEY, LEON P (DPM)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:P
Last Name:HICKEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SHAPE DR
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6601
Mailing Address - Country:US
Mailing Address - Phone:207-985-7174
Mailing Address - Fax:207-985-1304
Practice Address - Street 1:7 SHAPE DR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6601
Practice Address - Country:US
Practice Address - Phone:207-985-7174
Practice Address - Fax:207-985-1304
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1052213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431833399Medicaid
ME431833399Medicaid
MET25721Medicare UPIN