Healthcare Provider Details

I. General information

NPI: 1639140171
Provider Name (Legal Business Name): HORACE O. HICKMAN JR. M.D., J.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 E STOP 11 RD
INDIANAPOLIS IN
46237-6345
US

IV. Provider business mailing address

PO BOX 664056
INDIANAPOLIS IN
46266-4056
US

V. Phone/Fax

Practice location:
  • Phone: 317-893-1900
  • Fax: 317-893-1869
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01023443A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number01023443A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: