Provider Demographics
NPI:1740286558
Name:HICKEY, DONALD K (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:K
Last Name:HICKEY
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 1:3355 GLENDALE AVE.
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-5555
Mailing Address - Fax:419-383-3113
Practice Address - Street 1:3333 GLENDALE AVE.
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614
Practice Address - Country:US
Practice Address - Phone:419-383-5555
Practice Address - Fax:419-383-3113
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH141974OtherCARE CHOICES
OH000000296936OtherANTHEM-CHS
OH4203593OtherAETNA
OH000000030538OtherANTHEM MEDICAID WWK
OH002985OtherNATIONWIDE
OH01-04066OtherUNITED
MI7244OtherHPM
OH9564035002OtherCIGNA
OH000000030538OtherANTHEM-WWK-
OH000000200605OtherANTHEM MEDICAID CHS
OHH587370OtherUTP MEDICARE PIN
OH0540392Medicaid
OH344428256079OtherCARESOURCES
OH0540392Medicaid
MI7244OtherHPM