Provider Demographics
NPI:1912137456
Name:HICKMAN, MICHAEL WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4730 E INDIAN SCHOOL RD
Mailing Address - Street 2:#211
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5441
Mailing Address - Country:US
Mailing Address - Phone:602-354-3491
Mailing Address - Fax:602-595-8567
Practice Address - Street 1:4730 E INDIAN SCHOOL RD
Practice Address - Street 2:#211
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5441
Practice Address - Country:US
Practice Address - Phone:602-354-3491
Practice Address - Fax:602-595-8567
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005290207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine