Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 01056396 | IN |
NPI | 1073618575 |
---|---|
Provider Name | Shaun Hicks |
First Address | Indianapolis, IN 46268-0952 |
Second Address | Indianapolis, IN 46260-2479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 19/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H74620 | (02) |