Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 45733 | MN |
NPI | 1598756157 |
---|---|
Provider Name | William B Hicks |
First Address | Maplewood, MN 55109-5439 |
Second Address | Maplewood, MN 55109-5439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 21/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1012141 | PREFERRED ONE (01) | |
1202579 | MEDICA HEALTH PLANS (01) | |
120L2HI | BLUE CROSS BLUE SHIELD (01) | |
1854601 | ARAZ GROPU AMERICAS PPO (01) | |
2114155 | FIRST HEALTH PLAN (01) | |
784406900 | MEDICAL ASSISTANCE (01) | |
H86879 | (02) | |
HP38893 | HEALTH PARTNERS (01) |