Healthcare Provider Details

I. General information

NPI: 1538100078
Provider Name (Legal Business Name): KEITH GREGORY HICKEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 LINDBERG DR STE 2100
SLIDELL LA
70458-8064
US

IV. Provider business mailing address

1810 LINDBERG DR STE 2100
SLIDELL LA
70458-8064
US

V. Phone/Fax

Practice location:
  • Phone: 985-649-2700
  • Fax: 985-649-8488
Mailing address:
  • Phone: 985-649-2700
  • Fax: 985-649-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4297-320
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13878R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: