Healthcare Provider Details

I. General information

NPI: 1063480499
Provider Name (Legal Business Name): MARK G HICKEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 SPRUCE ST STE 1H
LOUISVILLE CO
80027-1977
US

IV. Provider business mailing address

950 SPRUCE ST STE 1H
LOUISVILLE CO
80027-1977
US

V. Phone/Fax

Practice location:
  • Phone: 720-598-1189
  • Fax:
Mailing address:
  • Phone: 720-625-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberDR-48317
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: