Provider Demographics
NPI:1639117054
Name:MANGRICH HICKMAN, ELIZABETH A (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:MANGRICH HICKMAN
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-624-2991
Mailing Address - Fax:319-624-3931
Practice Address - Street 1:510 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:IA
Practice Address - Zip Code:52333-9782
Practice Address - Country:US
Practice Address - Phone:319-624-2991
Practice Address - Fax:319-624-3931
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-35325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1286526Medicaid
IAP00269239OtherRAILROAD MEDICARE
IAI15737Medicare PIN
IAP00269239OtherRAILROAD MEDICARE