Provider Demographics
NPI:1982959235
Name:HICKS, ELIZABETH SHOKOUI (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SHOKOUI
Last Name:HICKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:MAHEEN
Other - Last Name:SHOKOUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:827 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2015
Practice Address - Country:US
Practice Address - Phone:231-775-9741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL1597207Q00000X
MI5101021221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine